Provider Demographics
NPI:1013242544
Name:WATSON, CELESTE M (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 N HILLS ST APT 607
Mailing Address - Street 2:#607
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-2559
Mailing Address - Country:US
Mailing Address - Phone:601-282-5429
Mailing Address - Fax:
Practice Address - Street 1:3315 N HILLS ST APT 607
Practice Address - Street 2:#607
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2559
Practice Address - Country:US
Practice Address - Phone:601-282-5429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2009003601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily