Provider Demographics
NPI:1477033249
Name:WATKINS, WENDY WARNER (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:WARNER
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E POINSETT ST
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-3404
Mailing Address - Country:US
Mailing Address - Phone:864-915-2640
Mailing Address - Fax:
Practice Address - Street 1:108 E POINSETT ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-3404
Practice Address - Country:US
Practice Address - Phone:864-915-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1073995015OtherPRIVATE PAY