Healthcare Provider Details

I. General information

NPI: 1760312458
Provider Name (Legal Business Name): HOLTEN WATSON MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W KINGSHIGHWAY
PARAGOULD AR
72450-5942
US

IV. Provider business mailing address

5109 RESERVE BLVD APT B500
JONESBORO AR
72405-8566
US

V. Phone/Fax

Practice location:
  • Phone: 870-239-7188
  • Fax:
Mailing address:
  • Phone: 501-827-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: