Provider Demographics
NPI:1275924607
Name:WATSON, STEFANI (NP)
Entity Type:Individual
Prefix:
First Name:STEFANI
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 1:1521 S STAPLES ST STE 601
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3154
Mailing Address - Country:US
Mailing Address - Phone:361-887-8451
Mailing Address - Fax:361-887-6126
Practice Address - Street 1:1521 S STAPLES ST STE 601
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3154
Practice Address - Country:US
Practice Address - Phone:361-887-8451
Practice Address - Fax:361-887-6126
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily