Provider Demographics
NPI:1063485613
Name:WATSON, CECELIA (FNP)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CECELIA
Other - Middle Name:
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-443-3311
Mailing Address - Fax:907-443-4594
Practice Address - Street 1:1000 GREG KRUSCHEK AVE
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0966
Practice Address - Country:US
Practice Address - Phone:907-443-3311
Practice Address - Fax:907-443-4594
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0817Medicaid
P21554Medicare UPIN