Doctor Name: | COLENE WATKINS |
NPI Number: | 1841555992 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 2137 |
Business Practice Address: | 15 Exchange Dr Lugoff, SC - 290789198 |
Business Phone Number: | 8034083277 |
Business Fax Number: | 8034083277 |
Mailing Address: | Po Box 520, LUGOFF |
State: | SC |
Postal Code: | 290780520 |
Phone Number: | 8034083277 |
Fax Number: | 8034083282 |
NPI Enumeration Date: | 07/05/2012 |
NPI Last Update Date: | 04/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2137 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NE |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |