Provider Demographics
NPI:1174571095
Name:WATKINS, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2712
Mailing Address - Country:US
Mailing Address - Phone:270-826-8009
Mailing Address - Fax:270-826-7010
Practice Address - Street 1:1015 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2712
Practice Address - Country:US
Practice Address - Phone:270-826-8009
Practice Address - Fax:270-826-7010
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17298207Q00000X
IN01025270A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000042539OtherANTHEM
KY64172984Medicaid
269168OtherHEALTHLINK
KY00756005Medicare PIN
KY0396009Medicare PIN
IN532500GGMedicare ID - Type UnspecifiedIN MCR
KY00626001Medicare PIN
KY080103514Medicare ID - Type UnspecifiedKY RR MCR
269168OtherHEALTHLINK
000000042539OtherANTHEM