Provider Demographics
NPI:1487656898
Name:WATSON, VICKI ANN (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:ANN
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1460
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:1451 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8424
Practice Address - Country:US
Practice Address - Phone:540-368-5350
Practice Address - Fax:540-371-3075
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165004363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA9037OtherMCR RAILROAD GROUP
VAC02375OtherMEDICARE GROUP
VAC02375OtherMEDICARE GROUP
VAQ07351Medicare UPIN
VAP00384188Medicare PIN