Provider Demographics
NPI:1699208991
Name:WATLEY, DEANNA (FNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:WATLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8338
Mailing Address - Country:US
Mailing Address - Phone:817-916-5180
Mailing Address - Fax:817-916-5199
Practice Address - Street 1:2730 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8338
Practice Address - Country:US
Practice Address - Phone:817-916-5180
Practice Address - Fax:817-916-5199
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily