Provider Demographics
NPI:1174794069
Name:WATKINS, RUTHANNE M
Entity type:Individual
Prefix:DR
First Name:RUTHANNE
Middle Name:M
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1016
Mailing Address - Country:US
Mailing Address - Phone:681-342-3700
Mailing Address - Fax:304-848-0703
Practice Address - Street 1:1511 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1016
Practice Address - Country:US
Practice Address - Phone:681-342-3700
Practice Address - Fax:304-848-0703
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018332Medicaid
WVWV2426AMedicare PIN
WVWA4293851Medicare PIN