Provider Demographics
NPI:1154024495
Name:WATKINS, MARY ALLISON (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALLISON
Last Name:WATKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALLISON
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8206 HIGHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8105
Mailing Address - Country:US
Mailing Address - Phone:859-948-3843
Mailing Address - Fax:
Practice Address - Street 1:1350 BULL LEA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1247
Practice Address - Country:US
Practice Address - Phone:859-246-8000
Practice Address - Fax:859-246-8032
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health