Healthcare Provider Details

I. General information

NPI: 1376872549
Provider Name (Legal Business Name): JESSICA LYNN WATTS CMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 S 5TH ST BLDG 4
HUGO OK
74743-8013
US

IV. Provider business mailing address

1007 S 5TH ST
HUGO OK
74743-6237
US

V. Phone/Fax

Practice location:
  • Phone: 580-406-2816
  • Fax:
Mailing address:
  • Phone: 580-406-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number132087
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: