Provider Demographics
NPI:1346718715
Name:WATTS, CAROLINE D
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:D
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BULLARD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-3313
Mailing Address - Country:US
Mailing Address - Phone:769-251-4177
Mailing Address - Fax:
Practice Address - Street 1:840 E RIVER PL STE 603
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3441
Practice Address - Country:US
Practice Address - Phone:769-251-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide