Healthcare Provider Details

I. General information

NPI: 1477269991
Provider Name (Legal Business Name): ADDISON RYAN WATSON DNP, RN, EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-5897
US

IV. Provider business mailing address

2400 BENTLEY CT
COLUMBIA MO
65202-4312
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4141
  • Fax:
Mailing address:
  • Phone: 573-999-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP16132
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2012013122
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: