Provider Demographics
NPI:1093706350
Name:WATSON, AMY HELEN (NP, PAC, MSN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HELEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP, PAC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 E HERNDON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-228-6600
Mailing Address - Fax:559-226-3709
Practice Address - Street 1:568 E HERNDON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-228-6600
Practice Address - Fax:559-226-3709
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15291363L00000X, 207RN0300X
CA17617 PA-C207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15291OtherNURSE PRACTITIONER LICENS
CA17617OtherPHYSICIAN ASSISTANT