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General NPI Number Information
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NPI Number | 1558030684
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Entity Type | Individual
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Provider Name | TAMMY RENEA CHAVIS-WATSON FNP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 1516 PLEASANT HOPE RD
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City | FAIRMONT
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State | NC
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Zip | 28340-8990
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Country | US
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Telephone | 107-367-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 PLEASANT HOPE RD
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City | FAIRMONT
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State | NC
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Zip | 28340-8990
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Country | US
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Telephone | 107-367-3759
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5015285
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License Number State | NC
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