Provider Demographics
NPI:1649298175
Name:WATSON, MARVIN RAY (FNP-C)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:RAY
Last Name:WATSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARVIN
Other - Middle Name:RAY
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3525 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5317
Mailing Address - Country:US
Mailing Address - Phone:281-540-1018
Mailing Address - Fax:281-540-7581
Practice Address - Street 1:3525 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5317
Practice Address - Country:US
Practice Address - Phone:281-540-1018
Practice Address - Fax:281-540-7581
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX777525363LF0000X
TXDC6128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8125OtherBC/BS
TX8F22470Medicare PIN
TX8A8125OtherBC/BS
603880Medicare ID - Type Unspecified