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General NPI Number Information
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NPI Number | 1740951078
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Entity Type | Individual
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Provider Name | JESSICA LOUISE WATSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 6781 E US HIGHWAY 36
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City | AVON
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State | IN
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Zip | 46123-9700
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Country | US
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Telephone | 463-231-1404
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Fax | 463-777-5840
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Provider Business Mailing Address
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Address Line | 1601 W RANKIN ST
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City | FLINT
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State | MI
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Zip | 48504-2752
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Country | US
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Telephone | 317-225-9295
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71013713A
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License Number State | IN
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