Provider Demographics
NPI:1184126732
Name:WATKINS, SHEILA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:RAE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:RAE
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-5042
Mailing Address - Country:US
Mailing Address - Phone:309-202-3004
Mailing Address - Fax:
Practice Address - Street 1:10430 LOVELL CENTER DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3227
Practice Address - Country:US
Practice Address - Phone:865-693-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-006837363A00000X
TN1033220314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine