Individual
MRS. KELLI SUZANNE WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2400 UNSER BLVD SE STE 19400, RIO RANCHO, NM 87124-4740
(505) 253-6100
(505) 253-6179
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQEURQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2020-0113
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76328503
—
NM
Enumeration date
12/22/2020
Last updated
10/27/2021
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