Basic Information
| Provider Information | |||||||||
| NPI: | 1336319482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.M.S PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT. 453 PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752625 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 6252 YELLOWSTONE RD | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820093432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077782015 | ||||||||
| FaxNumber: | 3077787060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 435 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 10027099703 | 05 | NE | MEDICAID | 142755500 | 05 | WY | MEDICAID | 10027099702 | 05 | NE | MEDICAID | W33945 | 01 | WY | MEDICARE | OTHER | 1688 | 01 | CO | LICENSE | OTHER | 2D4405 | 01 | CO | MEDICARE | OTHER | 435 | 01 | WY | WY LIC 435 | OTHER | 10027099700 | 05 | NE | MEDICAID |