Provider Demographics
NPI:1851645931
Name:WATKIN, HOLLI (CNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:
Last Name:WATKIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 BELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSET
Mailing Address - State:SD
Mailing Address - Zip Code:57718-9271
Mailing Address - Country:US
Mailing Address - Phone:605-890-2517
Mailing Address - Fax:
Practice Address - Street 1:1601 MONMOUTH ST STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-1019
Practice Address - Country:US
Practice Address - Phone:503-838-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201909639NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500772076Medicaid
OR500772076Medicaid