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General NPI Number Information
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NPI Number | 1124571187
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Entity Type | Individual
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Provider Name | JENNETTE WATTS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 348 N BLUFF ST # 202
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City | ST GEORGE
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State | UT
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Zip | 84770-4832
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Country | US
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Telephone | 435-772-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 3770 CARRIBBEAN CIRCLE
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City | ST GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 435-772-5370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1891478900
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License Number State | UT
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