Provider Demographics
NPI:1558946871
Name:WATSON, MELISSA ADRIANNE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ADRIANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-C
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Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:1950 S SONOMA RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1706
Practice Address - Country:US
Practice Address - Phone:575-525-4811
Practice Address - Fax:575-525-4812
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM63025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66101875Medicaid