Provider Demographics
NPI:1497805725
Name:WATKINS, ALICE PAULINE (FNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:PAULINE
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 1:108 E HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-2223
Mailing Address - Country:US
Mailing Address - Phone:765-584-1639
Mailing Address - Fax:765-584-4711
Practice Address - Street 1:108 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-2223
Practice Address - Country:US
Practice Address - Phone:765-584-1639
Practice Address - Fax:765-584-4711
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001624A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71001624AOtherIN LICENCE
IN201035340Medicaid
IN201035340Medicaid
INQ14830Medicare UPIN