Provider Demographics
NPI:1275591125
Name:WATSON, RHODA (NP)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:
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 1:107 RED OAK ST S
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-7319
Mailing Address - Country:US
Mailing Address - Phone:817-371-0799
Mailing Address - Fax:
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAVILLION III, 2ND FLOOR, SUITE 268
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203
Practice Address - Country:US
Practice Address - Phone:214-947-4448
Practice Address - Fax:214-947-4446
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610032363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00883507OtherPALMETTO RR
TXDQ5280OtherMEDICARE RR PALMETTO
TX175116601Medicaid
TXQ45444Medicare UPIN
TXTXB109991Medicare PIN
TXDQ5280OtherMEDICARE RR PALMETTO