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General NPI Number Information
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NPI Number | 1548899156
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Entity Type | Individual
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Provider Name | JORDYN L WATTS ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2431
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Country | US
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Telephone | 208-743-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E CACTUS AVE
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City | POST FALLS
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State | ID
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Zip | 83854-6066
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Country | US
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Telephone | 208-365-8161
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Fax | 877-389-5153
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60283274
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP61063402
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 68454
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License Number State | ID
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