Provider Demographics
NPI:1558030684
Name:CHAVIS-WATSON, TAMMY RENEA (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENEA
Last Name:CHAVIS-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 1:1516 PLEASANT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-8990
Mailing Address - Country:US
Mailing Address - Phone:107-367-3759
Mailing Address - Fax:
Practice Address - Street 1:1516 PLEASANT HOPE RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-8990
Practice Address - Country:US
Practice Address - Phone:107-367-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015285363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily