Provider Demographics
NPI:1689090060
Name:WATKINS, JUSTEN (DO)
Entity Type:Individual
Prefix:
First Name:JUSTEN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:DO
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 60
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:KS
Mailing Address - Zip Code:67839-0060
Mailing Address - Country:US
Mailing Address - Phone:620-397-3442
Mailing Address - Fax:
Practice Address - Street 1:135 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:KS
Practice Address - Zip Code:67839-0060
Practice Address - Country:US
Practice Address - Phone:785-953-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13585208D00000X
NVDO2475208D00000X
AZ007214208D00000X
UT11532150-1204208D00000X
KS05-45247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000000OtherNONE