Provider Demographics
NPI:1841525961
Name:WATTS, CANDY (APRN, CNS, C-NP)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:APRN, CNS, C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:STE 1105
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:918-579-5749
Practice Address - Fax:918-560-5791
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60794363LF0000X
OK0060794364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily