Individual
SHANNON REBECCA WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
233 WATKINS LN, JACKSBORO, TN 37757-3826
(423) 494-8819
Mailing address
233 WATKINS LN, JACKSBORO, TN 37757-3826
(423) 494-8819
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
75356
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75356
STATE OF TN NURSING BOARD
TN
Enumeration date
06/17/2015
Last updated
06/17/2015
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