Basic Information
| Provider Information | |||||||||
| NPI: | 1013095355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP APRN BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8520 BOUNDARY AVE | ||||||||
| Address2: | #F4 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073378520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 KANAKANAK ROAD | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | DILLINGHAM | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078429218 | ||||||||
| FaxNumber: | 9078429250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 432 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 44324 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP2826 | 05 | AK | MEDICAID |