Provider Demographics
NPI:1760816243
Name:WATSON, PATRA DENISE (BA)
Entity Type:Individual
Prefix:
First Name:PATRA
Middle Name:DENISE
Last Name:WATSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 N STATE HIGHWAY 91 APT 225
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-0002
Mailing Address - Country:US
Mailing Address - Phone:903-624-0204
Mailing Address - Fax:
Practice Address - Street 1:1105 LYNNWOOD ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2919
Practice Address - Country:US
Practice Address - Phone:580-924-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator