Provider Demographics
NPI:1750992756
Name:WATSON, DERRICK EMANUEL (RRT-NPS)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:EMANUEL
Last Name:WATSON
Suffix:
Gender:M
Credentials:RRT-NPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 LAKE RD STE 2101
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1561
Mailing Address - Country:US
Mailing Address - Phone:254-415-1727
Mailing Address - Fax:
Practice Address - Street 1:127 LAKE RD STE 2101
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1561
Practice Address - Country:US
Practice Address - Phone:254-415-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP00072347227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered