Provider Demographics
NPI:1861506172
Name:WATSON, DEBRA L (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-9515
Mailing Address - Country:US
Mailing Address - Phone:254-848-9180
Mailing Address - Fax:254-848-9180
Practice Address - Street 1:100 HILLCREST MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8897
Practice Address - Country:US
Practice Address - Phone:254-202-5870
Practice Address - Fax:254-202-5839
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX457940367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88469UOtherBCBS
TX194831701Medicaid
TX003052001Medicaid
TX194831701Medicaid
TX003052001Medicaid