Provider Demographics
NPI:1306186176
Name:WATKINS, MISTY JEWELL (RN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:JEWELL
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4168 HEDGES RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9044
Mailing Address - Country:US
Mailing Address - Phone:580-504-4922
Mailing Address - Fax:580-220-6499
Practice Address - Street 1:4168 HEDGES RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9044
Practice Address - Country:US
Practice Address - Phone:580-504-4922
Practice Address - Fax:580-220-6499
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse