Healthcare Provider Details

I. General information

NPI: 1699208991
Provider Name (Legal Business Name): DEANNA WATLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 HARRY HINES BLVD STE 925
DALLAS TX
75235-5331
US

IV. Provider business mailing address

5939 HARRY HINES BLVD STE 925
DALLAS TX
75235-5331
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-2870
  • Fax:
Mailing address:
  • Phone: 214-645-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133560
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: