Provider Demographics
NPI:1720040223
Name:WATSON, RACHEL DAWN (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:WATSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 NW 135TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4009
Mailing Address - Country:US
Mailing Address - Phone:405-753-6142
Mailing Address - Fax:405-730-8089
Practice Address - Street 1:3418 NW 135TH ST STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4009
Practice Address - Country:US
Practice Address - Phone:405-753-6142
Practice Address - Fax:405-730-8089
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX773793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L23031Medicare PIN
TXQ55493Medicare UPIN