Provider Demographics
NPI:1750344834
Name:WATSON, JENNIFER A (ARNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W APPLEWAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-9330
Mailing Address - Country:US
Mailing Address - Phone:208-665-1552
Mailing Address - Fax:208-665-1558
Practice Address - Street 1:714 W APPLEWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-9330
Practice Address - Country:US
Practice Address - Phone:208-665-1552
Practice Address - Fax:208-665-1558
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP438A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805997200Medicaid
ID805997201Medicaid
ID805997202Medicaid
ID805997203Medicaid