Provider Demographics
NPI:1497758841
Name:WATSON, CYNTHIA STEWART (FNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:STEWART
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DANBURY CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5400
Mailing Address - Country:US
Mailing Address - Phone:337-873-1994
Mailing Address - Fax:
Practice Address - Street 1:104 DANBURY CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5400
Practice Address - Country:US
Practice Address - Phone:337-873-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1433187Medicaid
LAP16159Medicare UPIN
LA1433187Medicaid