Healthcare Provider Details

I. General information

NPI: 1578228417
Provider Name (Legal Business Name): KATHERINE MARIE WATTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 CLAYTON BLVD
CLAYTON NC
27520-2144
US

IV. Provider business mailing address

11911 CLAYTON BLVD
CLAYTON NC
27520-2144
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-2900
  • Fax:
Mailing address:
  • Phone: 919-359-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017366
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016135
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number350491
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: