Provider Demographics
NPI:1467145474
Name:WATKINS, ELYSE A (FNP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19671 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2514
Mailing Address - Country:US
Mailing Address - Phone:248-840-1645
Mailing Address - Fax:
Practice Address - Street 1:2469 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3883
Practice Address - Country:US
Practice Address - Phone:810-407-6039
Practice Address - Fax:810-407-8834
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304338363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care