Provider Demographics
NPI:1598130361
Name:WATTS, HATIRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:HATIRA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 RODD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3901
Mailing Address - Country:US
Mailing Address - Phone:361-658-7869
Mailing Address - Fax:
Practice Address - Street 1:3126 RODD FIELD RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3901
Practice Address - Country:US
Practice Address - Phone:361-452-6898
Practice Address - Fax:361-452-6870
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353493501Medicaid