Provider Demographics
NPI:1881952687
Name:WATKINS, JESSICA ANNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:WATKINS
Suffix:
Gender:F
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:PO. BOX 16852
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24209-6852
Mailing Address - Country:US
Mailing Address - Phone:276-466-1600
Mailing Address - Fax:276-466-2800
Practice Address - Street 1:433 SCOTT ST.
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:276-466-1600
Practice Address - Fax:276-466-2800
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16456363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF1011057OtherAANP