Provider Demographics
NPI:1811912207
Name:WATSON, NANCY (NP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 SCHNEIDER DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4811
Mailing Address - Country:US
Mailing Address - Phone:870-942-3099
Mailing Address - Fax:870-942-2219
Practice Address - Street 1:109 WEST PINE ST.
Practice Address - Street 2:SUITE A
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150
Practice Address - Country:US
Practice Address - Phone:870-942-3099
Practice Address - Fax:870-942-2219
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP01341363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T179Medicare ID - Type Unspecified