Healthcare Provider Details

I. General information

NPI: 1093706350
Provider Name (Legal Business Name): AMY HELEN WATSON NP, PAC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE SUITE 201
FRESNO CA
93720-2989
US

IV. Provider business mailing address

560 E HERNDON AVE STE 201
FRESNO CA
93720-2824
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax: 559-226-3709
Mailing address:
  • Phone: 559-437-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number17617
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15291
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number562830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: