Provider Demographics
NPI:1760165120
Name:WATKINS, COURTNEY JO (APRN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JO
Last Name:WATKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 CROZIER AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1775
Mailing Address - Country:US
Mailing Address - Phone:812-493-5652
Mailing Address - Fax:
Practice Address - Street 1:220 CLIFTY DR STE I
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1669
Practice Address - Country:US
Practice Address - Phone:812-580-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF10220288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily