Individual
MARY SUE WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
1014 ROSE ST, PRENTISS, MS 39474-5271
(601) 792-2071
(601) 792-8134
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 796-7030
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R733881
MS
363LF0000X
Family Nurse Practitioner
R733881
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117238
—
MS
01
—
P00445055
RAILROAD MEDICARE
MS
Enumeration date
10/02/2006
Last updated
11/06/2019
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