Healthcare Provider Details

I. General information

NPI: 1407279359
Provider Name (Legal Business Name): DAVID I.A. WATTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-472-4357
  • Fax: 512-703-1394
Mailing address:
  • Phone: 512-472-4357
  • Fax: 512-703-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number559739
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: