Provider Demographics
NPI:1831161702
Name:WATSON, ANN KATHERINE (PAC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:KATHERINE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DOCTORS ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675
Mailing Address - Country:US
Mailing Address - Phone:336-372-5606
Mailing Address - Fax:336-372-6211
Practice Address - Street 1:214 DOCTORS ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9247
Practice Address - Country:US
Practice Address - Phone:336-372-5606
Practice Address - Fax:336-372-6211
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00103094OtherRAILROAD MEDICARE
P00106094OtherUNITED HEALTHCARE
NC2750037Medicare PIN
S74400Medicare UPIN