Provider Demographics
NPI:1649283979
Name:WATKINS, DAVID JACK (FNP-BC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JACK
Last Name:WATKINS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:435-528-2130
Mailing Address - Fax:435-528-2186
Practice Address - Street 1:131 E MAIN ST
Practice Address - Street 2:STE. 3
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-1335
Practice Address - Country:US
Practice Address - Phone:435-528-2130
Practice Address - Fax:435-528-2186
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT293477-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily