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NPI Code Detail

MEDICARE: NICOLE LOUISE WATSON PA-C, MPAS

MEDICARE: NICOLE LOUISE WATSON PA-C, MPAS
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
1363AS0400XSurgical Physician AssistantPA23154CA
2363A00000XPhysician Assistant1628NV

General Provider Information

NPI Number : 1194159350
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LOUISE WATSON PA-C, MPAS
Provider Business Mailing Address
First Line : 1800 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2386
Country : US
Telephone Number : 702-383-2620
Fax Number :
Provider Business Practice Location Address
First Line : 620 SHADOW LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4119
Country : US
Telephone Number : 23-884-0007
Fax Number : 702-476-2040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2013
Last Update Date : 04/07/2026

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