Provider Demographics
NPI:1730527920
Name:WATKINS, PAULA MICHELLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MICHELLE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11256 MOUNT LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-2510
Mailing Address - Country:US
Mailing Address - Phone:205-495-7112
Mailing Address - Fax:
Practice Address - Street 1:4280 WATERMELON RD STE 110
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5250
Practice Address - Country:US
Practice Address - Phone:205-710-3838
Practice Address - Fax:205-710-3839
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-088012363LA2200X, 363LW0102X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL173930Medicaid
AL173930Medicaid