Provider Demographics
NPI:1619569456
Name:WATSON, NICOLE AMY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMY
Last Name:WATSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6979 S HOLLY CIR STE 215
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1423
Mailing Address - Country:US
Mailing Address - Phone:720-773-4771
Mailing Address - Fax:720-414-1530
Practice Address - Street 1:6979 S HOLLY CIR STE 215
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1423
Practice Address - Country:US
Practice Address - Phone:720-773-4771
Practice Address - Fax:720-414-1530
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996230-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health