Provider Demographics
NPI:1407960941
Name:WATKINS, CHELETTA LASHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELETTA
Middle Name:LASHELLE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N BUCKNER BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1151 N BUCKNER BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3426
Practice Address - Country:US
Practice Address - Phone:214-321-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH31092Medicare UPIN