Provider Demographics
NPI:1639506835
Name:WATTS, JANE' M (NP-C)
Entity Type:Individual
Prefix:
First Name:JANE'
Middle Name:M
Last Name:WATTS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 HESSMER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7041
Mailing Address - Country:US
Mailing Address - Phone:504-754-2334
Mailing Address - Fax:504-324-2078
Practice Address - Street 1:4520 WICHERS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3135
Practice Address - Country:US
Practice Address - Phone:504-754-2334
Practice Address - Fax:504-324-2078
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP07532OtherAPRN
LA2346644Medicaid