Provider Demographics
NPI:1073315792
Name:WATKINS, SHAVONN R (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAVONN
Middle Name:R
Last Name:WATKINS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHAVONN
Other - Middle Name:R
Other - Last Name:WHITEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:11960 LEBANON PINEGROVE RD
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-9268
Mailing Address - Country:US
Mailing Address - Phone:601-473-1964
Mailing Address - Fax:
Practice Address - Street 1:11960 LEBANON PINEGROVE RD
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-9268
Practice Address - Country:US
Practice Address - Phone:601-473-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula