Provider Demographics
NPI:1104065077
Name:WATKINS, KERRI MICHEL
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:MICHEL
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 1:602 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2640
Mailing Address - Country:US
Mailing Address - Phone:307-359-1115
Mailing Address - Fax:
Practice Address - Street 1:209 E CENTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2544
Practice Address - Country:US
Practice Address - Phone:307-359-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist