Provider Demographics
NPI:1487249447
Name:WATKINS, DONNA R
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CYCLONE
Mailing Address - State:WV
Mailing Address - Zip Code:24827-9412
Mailing Address - Country:US
Mailing Address - Phone:681-368-2597
Mailing Address - Fax:
Practice Address - Street 1:4910 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CYCLONE
Practice Address - State:WV
Practice Address - Zip Code:24827-9412
Practice Address - Country:US
Practice Address - Phone:681-368-2597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant