Provider Demographics
NPI:1851502009
Name:WATSON, TERRIE B (FNP)
Entity Type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:B
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERRIE
Other - Middle Name:B
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1009 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4331
Mailing Address - Country:US
Mailing Address - Phone:731-407-9700
Mailing Address - Fax:731-407-9701
Practice Address - Street 1:1009 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4331
Practice Address - Country:US
Practice Address - Phone:731-407-9700
Practice Address - Fax:731-407-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000055927363LF0000X
TNAPN0000012936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341378Medicaid
TN1932134871Medicare UPIN
TN3341378Medicare PIN
TN10350I8011Medicare PIN