Healthcare Provider Details

I. General information

NPI: 1063091205
Provider Name (Legal Business Name): MONIQUE M WATSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 KNIGHT ARNOLD RD
MEMPHIS TN
38118-2128
US

IV. Provider business mailing address

1160 VICKERY LN STE 103
CORDOVA TN
38016-1647
US

V. Phone/Fax

Practice location:
  • Phone: 901-505-0690
  • Fax:
Mailing address:
  • Phone: 901-877-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82464-012
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number135847
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11026933
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209027389
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number30880
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61422162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: