Provider Demographics
NPI:1386511731
Name:WATSON, JESSICA S
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 TOWN BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:NY
Mailing Address - Zip Code:13788-2809
Mailing Address - Country:US
Mailing Address - Phone:607-221-2994
Mailing Address - Fax:
Practice Address - Street 1:460 ANDES RD
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-7443
Practice Address - Country:US
Practice Address - Phone:607-746-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY750917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine