Provider Demographics
NPI:1497745103
Name:WATSON-LEARY, ERIKA V (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:V
Last Name:WATSON-LEARY
Suffix:
Gender:F
Credentials:CRNA
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 22926
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2926
Mailing Address - Country:US
Mailing Address - Phone:713-400-2990
Mailing Address - Fax:713-400-2993
Practice Address - Street 1:1635 NORTH LOOP WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1593
Practice Address - Country:US
Practice Address - Phone:713-400-2990
Practice Address - Fax:713-400-2993
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX602319367500000X
TXRN602319367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85904UOtherBLUE CROSS/BLUE SHIELD
TX003182511Medicaid
TX003182506Medicaid
TX82841UOtherBLUE CROSS/BLUE SHIELD
TX050332OtherAANA RECERTIFICATION
TX82841UOtherBLUE CROSS/BLUE SHIELD
TX85904UOtherBLUE CROSS/BLUE SHIELD
S83279Medicare UPIN