Provider Demographics
NPI:1083785018
Name:WATT, PAULA J (PHD, APRN-BC, FNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:WATT
Suffix:
Gender:F
Credentials:PHD, APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EDWARDS HALL
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-0001
Mailing Address - Country:US
Mailing Address - Phone:864-656-3076
Mailing Address - Fax:864-656-7694
Practice Address - Street 1:101 EDWARDS HALL
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-0001
Practice Address - Country:US
Practice Address - Phone:864-656-3076
Practice Address - Fax:864-656-7694
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF1112363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS90781Medicare UPIN