Healthcare Provider Details

I. General information

NPI: 1841525961
Provider Name (Legal Business Name): CANDY WATTS APRN, CNS, C-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S UTICA AVE STE 1105
TULSA OK
74104-4000
US

IV. Provider business mailing address

PO BOX 2369
BORREGO SPRINGS CA
92004-2369
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5749
  • Fax: 918-560-5791
Mailing address:
  • Phone: 760-767-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60794
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number0060794
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: