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General NPI Number Information
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NPI Number | 1538462858
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Entity Type | Individual
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Provider Name | STACYE E WATSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 2021 HAMILTON PLACE BLVD SUITE G
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6046
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Country | US
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Telephone | 423-899-6222
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Fax | 423-490-0294
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Provider Business Mailing Address
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Address Line | 6170 SHALLOWFORD RD SUITE 101
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1892
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Country | US
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Telephone | 423-648-4500
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Fax | 423-648-8117
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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 | APN15278
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License Number State | TN
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