Provider Demographics
NPI:1124317995
Name:WATKINS, CASEY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:NICOLE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-432-0335
Mailing Address - Fax:307-432-0341
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-432-0335
Practice Address - Fax:307-432-0341
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD041597207R00000X
390200000X
WYTL3638207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program