Provider Demographics
NPI:1336572205
Name:WATT, JEREMIAH (FNP)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:WATT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RIVERVIEW A
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1414
Mailing Address - Country:US
Mailing Address - Phone:406-781-3323
Mailing Address - Fax:
Practice Address - Street 1:900 6TH ST SW STE 2
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3207
Practice Address - Country:US
Practice Address - Phone:406-727-3242
Practice Address - Fax:406-727-3161
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100650363L00000X
MT32204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily