Individual
KELLIE J WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
129 FOUNTAINS BLVD, MADISON, MS 39110
(769) 300-0730
Mailing address
129 FOUNTAINS BLVD, MADISON, MS 39110-6318
(769) 300-0730
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902465
MS
Other
Enumeration date
01/05/2018
Last updated
10/25/2021
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