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General NPI Number Information
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NPI Number | 1497379770
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Entity Type | Individual
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Provider Name | JACQUELINE ANNE WATTS PA
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 23 PORTSMOUTH AVE
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City | STRATHAM
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State | NH
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Zip | 03885-2520
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Country | US
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Telephone | 603-942-2171
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Fax | 603-371-3104
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Provider Business Mailing Address
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Address Line | 111 NEW HAMPSHIRE AVE STE 2
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City | PORTSMOUTH
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State | NH
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Zip | 03801-2864
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Country | US
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Telephone | 330-271-8589
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Fax | 330-965-9325
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1648
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2105
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License Number State | ME
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