Provider Demographics
NPI:1154476059
Name:WATSON, JULIA ANN (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0587
Mailing Address - Country:US
Mailing Address - Phone:208-814-7400
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:100 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-0000
Practice Address - Country:US
Practice Address - Phone:208-622-8811
Practice Address - Fax:208-622-6921
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP197A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805190200Medicaid
ID805190200Medicaid
ID13443201Medicare PIN