Healthcare Provider Details

I. General information

NPI: 1811004500
Provider Name (Legal Business Name): MARY ELIZABETH WATSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WEST 7TH STREET
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

120 HONEY HOLLER ROAD
BALD KNOB AR
72010
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-5094
  • Fax: 501-257-6179
Mailing address:
  • Phone: 501-724-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberS01015
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: