Provider Demographics
NPI:1891761649
Name:WATTS, JENELLE S (MD)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:S
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 COIT RD STE 480-221
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3797
Mailing Address - Country:US
Mailing Address - Phone:469-277-9103
Mailing Address - Fax:
Practice Address - Street 1:3804 W 15TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4752
Practice Address - Country:US
Practice Address - Phone:469-326-1600
Practice Address - Fax:469-326-1608
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6407207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202173501Medicaid
TX202173504Medicaid
TX202173501Medicaid
TX202173504Medicaid