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NPI Code Detail

MEDICARE: MRS. AMY HELEN WATSON NP, PAC, MSN

MEDICARE: MRS. AMY HELEN WATSON NP, PAC, MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse562830CA
2363A00000XPhysician Assistant17617CA
3363L00000XNurse Practitioner15291CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115291OTHERCANURSE PRACTITIONER LICENS
217617OTHERCAPHYSICIAN ASSISTANT

General Provider Information

NPI Number : 1093706350
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY HELEN WATSON NP, PAC, MSN
Provider Business Mailing Address
First Line : 560 E HERNDON AVE STE 201
Second Line :
City : FRESNO
State : CA
Zip : 93720-2824
Country : US
Telephone Number : 559-437-7304
Fax Number :
Provider Business Practice Location Address
First Line : 568 E HERNDON AVE
Second Line : SUITE 201
City : FRESNO
State : CA
Zip : 93720-2989
Country : US
Telephone Number : 559-228-6600
Fax Number : 559-226-3709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 01/03/2025

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