MEDICARE: MISS TERA PATRICIA WATTS PA-C

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	363A00000X	Physician Assistant	PA08482	TX

General Provider Information

NPI Number	:	1689001406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TERA PATRICIA WATTS PA-C

Provider Business Mailing Address
First Line	:	6844 HARRIS PARKWAY
Second Line	:
City	:	FT. WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-263-0007
Fax Number	:	817-263-1118

Provider Business Practice Location Address
First Line	:	320 MERCEDES ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2593
Country	:	US
Telephone Number	:	817-249-7323
Fax Number	:

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

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	02/05/2025

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