Provider Demographics
NPI:1952842304
Name:WATSON, ALEXANDRA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:WATSON
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 1:1200 MOUNTAIN STREET
Mailing Address - Street 2:FAMILY MEDICINE CENTER
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-0001
Mailing Address - Country:US
Mailing Address - Phone:775-882-1324
Mailing Address - Fax:
Practice Address - Street 1:1200 MOUNTAIN ST STE 230
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3867
Practice Address - Country:US
Practice Address - Phone:775-882-1324
Practice Address - Fax:775-882-3859
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV21836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program