Provider Demographics
NPI:1477793479
Name:JEROME WATSON LLC
Entity Type:Organization
Organization Name:JEROME WATSON LLC
Other - Org Name:JEROME WATSON LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:903-334-8132
Mailing Address - Street 1:7209 GOLDFINCH RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-0227
Mailing Address - Country:US
Mailing Address - Phone:903-334-8132
Mailing Address - Fax:
Practice Address - Street 1:7209 GOLDFINCH RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-0227
Practice Address - Country:US
Practice Address - Phone:903-334-8132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty