Provider Demographics
NPI:1669924379
Name:WATSON, STEPHANIE N (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BROOKES XING
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-1009
Mailing Address - Country:US
Mailing Address - Phone:662-489-4044
Mailing Address - Fax:662-489-4041
Practice Address - Street 1:12 BROOKES XING
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-1009
Practice Address - Country:US
Practice Address - Phone:662-489-4044
Practice Address - Fax:662-489-4041
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily