Healthcare Provider Details

I. General information

NPI: 1497676803
Provider Name (Legal Business Name): HUNTER ALLEN WATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16279 WALNUT ST
HESPERIA CA
92345-3622
US

IV. Provider business mailing address

4025 GOSS RD
PHELAN CA
92371-7746
US

V. Phone/Fax

Practice location:
  • Phone: 760-947-0070
  • Fax:
Mailing address:
  • Phone: 760-221-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: