Healthcare Provider Details

I. General information

NPI: 1710893573
Provider Name (Legal Business Name): NATALIE WATSON MAED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 MARY LOU RETTON DR
FAIRMONT WV
26554-2204
US

IV. Provider business mailing address

221 CESSNA DR
MORGANTOWN WV
26508-4307
US

V. Phone/Fax

Practice location:
  • Phone: 304-367-2100
  • Fax:
Mailing address:
  • Phone: 304-367-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberE2L151700233
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: