MEDICARE: ANGELA WATSON

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
1	171W00000X	Contractor		TX
2	347C00000X	Private Vehicle		TX
3	372600000X	Adult Companion
4	385H00000X	Respite Care		TX
5	246RP1900X	Phlebotomy Technician	124866-746012215	TX
6	261QP2400X	Prison Health Clinic/Center		TX
7	253Z00000X	In Home Supportive Care Agency
8	247ZC0005X	Clinical Laboratory Director (Non-physician)		TX

General Provider Information

NPI Number	:	1508110305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WATSON

Provider Business Mailing Address
First Line	:	3613 SANDGATE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-5230
Country	:	US
Telephone Number	:	469-882-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3613 SANDGATE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-5230
Country	:	US
Telephone Number	:	469-882-0171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	04/12/2026

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