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General NPI Number Information
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NPI Number | 1346718715
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Entity Type | Individual
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Provider Name | CAROLINE D WATTS
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Gender | Female
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 840 E RIVER PL STE 603
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City | JACKSON
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State | MS
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Zip | 39202-3441
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Country | US
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Telephone | 769-251-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 4440 BULLARD ST
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City | JACKSON
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State | MS
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Zip | 39209-3313
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Country | US
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Telephone | 769-251-4177
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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