Provider Demographics
NPI:1174945281
Name:WATKINS, JACQUELINE MARIE
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
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 1:15330 ELLA BLVD
Mailing Address - Street 2:APT 2409
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090
Mailing Address - Country:US
Mailing Address - Phone:205-886-0556
Mailing Address - Fax:
Practice Address - Street 1:440 BENMAR DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060
Practice Address - Country:US
Practice Address - Phone:205-886-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide