Healthcare Provider Details

I. General information

NPI: 1295690857
Provider Name (Legal Business Name): JENNIFER WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-0001
US

IV. Provider business mailing address

759 CHESTNUT ST
SPRINGFIELD MA
01199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 413-275-0444
  • Fax:
Mailing address:
  • Phone: 413-275-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2303253
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: