Provider Demographics
NPI:1356546162
Name:WATKINS, LEANNE Y (NP)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:Y
Last Name:WATKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50087
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0019
Mailing Address - Country:US
Mailing Address - Phone:864-330-1800
Mailing Address - Fax:
Practice Address - Street 1:1350 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-330-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3199208VP0000X
SCF3199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCK1161OtherMEDICARE RR
SCNP1121Medicaid
SCCK1161OtherMEDICARE RR
SCAA1983Medicare UPIN
SC1124Medicare PIN