Provider Demographics
NPI:1790262657
Name:WATTS, ASTRIN P (LVN)
Entity Type:Individual
Prefix:
First Name:ASTRIN
Middle Name:P
Last Name:WATTS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 COUNTY ROAD 1180
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-7947
Mailing Address - Country:US
Mailing Address - Phone:936-332-5183
Mailing Address - Fax:
Practice Address - Street 1:1414 COUNTY ROAD 1180
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-7947
Practice Address - Country:US
Practice Address - Phone:936-332-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163459164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse