Provider Demographics
NPI:1871155382
Name:WATKINS, LORRAINE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARIE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5742 SCOTT STATION RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:AL
Mailing Address - Zip Code:36765-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 JACK WARNER PKWY NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-1060
Practice Address - Country:US
Practice Address - Phone:205-462-4500
Practice Address - Fax:205-462-4586
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF06190812363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care