Healthcare Provider Details

I. General information

NPI: 1710692322
Provider Name (Legal Business Name): HEATHER WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 COMMONS CIR
YUKON OK
73099-9505
US

IV. Provider business mailing address

11501 LOCHWOOD DR APT 714
YUKON OK
73099-6660
US

V. Phone/Fax

Practice location:
  • Phone: 405-467-6782
  • Fax:
Mailing address:
  • Phone: 512-368-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: