=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588515407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE WATSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2026
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 N KENTUCKY AVE
-----------------------------------------------------
City | WEST PLAINS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65775-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-256-9111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 MCFARLAND DR APT B108
-----------------------------------------------------
City | WEST PLAINS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65775-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-257-6789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | 2022031811
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------