Provider Demographics
NPI:1619069002
Name:WALKER WATKINS, SHARON S (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:WALKER WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 N. RONALD REAGAN PARKWAY
Practice Address - Street 2:SUITE C1600
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-2500
Practice Address - Fax:317-217-2515
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036105998207V00000X
IN01071422A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105998Medicaid
IN201082300Medicaid
IN201082300Medicaid
A76470Medicare UPIN