Provider Demographics
NPI:1013095355
Name:WATKINS, CONNIE S (FNP APRN BC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:WATKINS
Suffix:
Gender:F
Credentials:FNP APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 BOUNDARY AVE
Mailing Address - Street 2:#F4
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-337-8520
Mailing Address - Fax:
Practice Address - Street 1:6000 KANAKANAK ROAD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-9218
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK432363LF0000X
KS44324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP2826Medicaid
AKP68982Medicare UPIN