Provider Demographics
NPI:1477093102
Name:WATKINS, MELISSA (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-2266
Mailing Address - Country:US
Mailing Address - Phone:334-305-0400
Mailing Address - Fax:334-305-0401
Practice Address - Street 1:1450 ROSS CLARK CIR STE 400
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4770
Practice Address - Country:US
Practice Address - Phone:334-305-0400
Practice Address - Fax:334-305-0401
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127160363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-127160OtherALABAMA NURSING LICENSE