Healthcare Provider Details

I. General information

NPI: 1073902276
Provider Name (Legal Business Name): BRANDI DAWN WATSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 HOSPITAL DR STE E-1
MOUNTAIN HOME AR
72653-2953
US

IV. Provider business mailing address

PO BOX 707
MOUNTAIN HOME AR
72654-0707
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-3200
  • Fax: 870-508-1359
Mailing address:
  • Phone: 870-424-7070
  • Fax: 870-424-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004335
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: