Provider Demographics
NPI:1801902465
Name:WATSON, PAUL T (RN, MS, FNP, ARNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:WATSON
Suffix:
Gender:M
Credentials:RN, MS, FNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NE TENNEY RD
Mailing Address - Street 2:STE 110 PMB 538
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2831
Mailing Address - Country:US
Mailing Address - Phone:360-936-9316
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:BLDG D7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:888-233-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005462363LF0000X
OR099007038N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily