Healthcare Provider Details

I. General information

NPI: 1568207215
Provider Name (Legal Business Name): RACHEL MACKENZIE WATSON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

1323 N MERION WAY APT 104
FAYETTEVILLE AR
72704-6407
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax:
Mailing address:
  • Phone: 615-268-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number270644
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: