Healthcare Provider Details

I. General information

NPI: 1669208369
Provider Name (Legal Business Name): JADA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W 15TH ST
EDMOND OK
73013-3621
US

IV. Provider business mailing address

820 W 15TH ST
EDMOND OK
73013-3621
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-1730
  • Fax:
Mailing address:
  • Phone: 405-858-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: