Healthcare Provider Details

I. General information

NPI: 1154059541
Provider Name (Legal Business Name): KAYLA NICOLE WATSON PMNHP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CIVIC CENTER BLVD
HOUMA LA
70360-5937
US

IV. Provider business mailing address

330 OAK HARBOR BLVD. SUITE B #1034
SLIDELL LA
70458
US

V. Phone/Fax

Practice location:
  • Phone: 985-333-2020
  • Fax: 985-851-0162
Mailing address:
  • Phone: 504-350-2800
  • Fax: 504-354-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number226781
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: