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General NPI Number Information
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NPI Number | 1487176368
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Entity Type | Individual
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Provider Name | JESSICA VELISSA WATTS NP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2901 N ELM ST
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City | LUMBERTON
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State | NC
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Zip | 28358-2982
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Country | US
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Telephone | 910-671-5395
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Fax | 910-739-3062
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Provider Business Mailing Address
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Address Line | 2901 N ELM ST
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City | LUMBERTON
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State | NC
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Zip | 28358-2982
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Country | US
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Telephone | 910-671-5395
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Fax | 910-739-3062
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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 | 5020822
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License Number State | NC
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