Provider Demographics
NPI:1255737169
Name:WATKINS, NITA (CMA)
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 MILL STREAM DR
Mailing Address - Street 2:#3
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7434
Mailing Address - Country:US
Mailing Address - Phone:901-396-4668
Mailing Address - Fax:
Practice Address - Street 1:315 LEMA PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3203
Practice Address - Country:US
Practice Address - Phone:901-401-0344
Practice Address - Fax:901-396-4668
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN855244246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN855244OtherNATIONAL CENTER FOR COMPETENCY TESTING