Healthcare Provider Details

I. General information

NPI: 1942136023
Provider Name (Legal Business Name): HOLLY DAWN WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY DAWN OSBORN RPSGT

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7185 1/2 NW 16TH ST
BETHANY OK
73008-5746
US

IV. Provider business mailing address

7185 1/2 NW 16TH ST
BETHANY OK
73008-5746
US

V. Phone/Fax

Practice location:
  • Phone: 405-210-1633
  • Fax:
Mailing address:
  • Phone: 405-210-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: