Healthcare Provider Details

I. General information

NPI: 1689803496
Provider Name (Legal Business Name): LOY ELIZABETH WATSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOY ELIZABETH MCEACHIN RN

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 E INDUSTRY ST
GIDDINGS TX
78942-4301
US

IV. Provider business mailing address

3008 STATE HIGHWAY 36 S
CALDWELL TX
77836-4712
US

V. Phone/Fax

Practice location:
  • Phone: 979-542-3042
  • Fax:
Mailing address:
  • Phone: 423-453-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP144094
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0000169929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: