Provider Demographics
NPI:1760135842
Name:WATKINS, KAYLYN (NRCMA)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:NRCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 DRUID HILLS DR # 104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4707
Mailing Address - Country:US
Mailing Address - Phone:214-997-5713
Mailing Address - Fax:
Practice Address - Street 1:4003 DRUID HILLS DR # 104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4707
Practice Address - Country:US
Practice Address - Phone:214-997-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
374U00000X
TX90418-283224121911363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No374U00000XNursing Service Related ProvidersHome Health Aide