Provider Demographics
NPI:1629214051
Name:WATSON, PATRICK
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S JEFFERSON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 S JEFFERSON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5948
Practice Address - Country:US
Practice Address - Phone:870-863-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARNONEOtherMENTAL HEALTH PARA PROFESSIONAL