Healthcare Provider Details

I. General information

NPI: 1558946871
Provider Name (Legal Business Name): MELISSA ADRIANNE WATSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 11/29/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S SONOMA RANCH BLVD
LAS CRUCES NM
88011-1706
US

IV. Provider business mailing address

385 CALLE DE ALEGRA STE A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-4811
  • Fax: 575-525-4812
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63025
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: