Individual
JARED LYLE WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(404) 502-8878
Mailing address
120 DEER RUN DR, LEWISVILLE, NC 27023-9795
(404) 502-8878
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
288449
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
6982
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/21/2020
Last updated
10/12/2022
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