Provider Demographics
NPI:1366435067
Name:WATKINS, KELLI V (MD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:V
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W PARKER RD
Mailing Address - Street 2:SUITE 306, MOB 1
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-981-7370
Mailing Address - Fax:972-981-7371
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:SUITE 306, MOB 1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-981-7370
Practice Address - Fax:972-981-7371
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH22129Medicare UPIN
TX8792K0Medicare ID - Type Unspecified