Provider Demographics
NPI:1467747782
Name:WATTS, DACIA N (ARNP)
Entity Type:Individual
Prefix:
First Name:DACIA
Middle Name:N
Last Name:WATTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DACIA
Other - Middle Name:N
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-8877
Mailing Address - Fax:319-384-0603
Practice Address - Street 1:201 S CLINTON ST STE 168
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4034
Practice Address - Country:US
Practice Address - Phone:319-384-8877
Practice Address - Fax:319-384-0603
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA112574163W00000X
MO2005031446163W00000X
CT98660163W00000X
CT04770363LF0000X
IAA112574363LF0000X, 363L00000X
IAA-112574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid