=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275466070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WATT FAMILY WELLNESS CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2026
-----------------------------------------------------
Last Update Date | 06/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 W MARKHAM ST
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-3412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-786-9138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1340 JOSITA CIR
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-786-9139
-----------------------------------------------------
Fax | 832-324-6972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN/PRESIDENT
-----------------------------------------------------
Name | SAMANTHA LYNN WATT
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 501-786-9139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------