Provider Demographics
NPI:1699153833
Name:WATKINS, ATHENA L (RN, MPH, MSN)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:L
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RN, MPH, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N CENTRAL AVE
Mailing Address - Street 2:B1
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1640
Mailing Address - Country:US
Mailing Address - Phone:888-417-5163
Mailing Address - Fax:888-316-1604
Practice Address - Street 1:2600 N CENTRAL AVE
Practice Address - Street 2:B1
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1640
Practice Address - Country:US
Practice Address - Phone:888-417-5163
Practice Address - Fax:888-316-1604
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022834163W00000X
CA544282163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse