Provider Demographics
NPI:1841443025
Name:WATKINS, LISA KAREN (A-MHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAREN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:A-MHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 GALLATIN DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-8887
Mailing Address - Country:US
Mailing Address - Phone:701-471-7066
Mailing Address - Fax:
Practice Address - Street 1:3020 GALLATIN DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-8887
Practice Address - Country:US
Practice Address - Phone:701-471-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29416363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health