Provider Demographics
NPI:1336657022
Name:WATTS, BRANDI (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357620 E 760 RD
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-6710
Mailing Address - Country:US
Mailing Address - Phone:405-301-7581
Mailing Address - Fax:
Practice Address - Street 1:1523 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5469
Practice Address - Country:US
Practice Address - Phone:405-377-5670
Practice Address - Fax:405-377-1880
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine