Provider Demographics
NPI:1629115019
Name:WATKINS, REBECCA P
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:P
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:P
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:440 DEFOE CIR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-2702
Mailing Address - Country:US
Mailing Address - Phone:865-984-6847
Mailing Address - Fax:
Practice Address - Street 1:1006 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5132
Practice Address - Country:US
Practice Address - Phone:865-983-4582
Practice Address - Fax:865-983-4574
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000047263251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare