Healthcare Provider Details

I. General information

NPI: 1538462858
Provider Name (Legal Business Name): STACYE E WATSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HAMILTON PLACE BLVD SUITE G
CHATTANOOGA TN
37421-6046
US

IV. Provider business mailing address

6170 SHALLOWFORD RD SUITE 101
CHATTANOOGA TN
37421-1892
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-6222
  • Fax: 423-490-0294
Mailing address:
  • Phone: 423-648-4500
  • Fax: 423-648-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN15278
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: