Healthcare Provider Details

I. General information

NPI: 1427814656
Provider Name (Legal Business Name): LAURA BETH WATTS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENTARA CIR STE 203
WILLIAMSBURG VA
23188-5727
US

IV. Provider business mailing address

6350 CENTER DR STE 200
NORFOLK VA
23502-4107
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-2236
  • Fax:
Mailing address:
  • Phone: 757-905-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: