Provider Demographics
NPI:1780052589
Name:WATERS, ADAM (CRNP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005-2260
Mailing Address - Country:US
Mailing Address - Phone:205-674-1222
Mailing Address - Fax:
Practice Address - Street 1:3915 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005-2260
Practice Address - Country:US
Practice Address - Phone:205-674-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily