MEDICARE: FARRAH WATERS PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	1-174428	AL

General Provider Information

NPI Number	:	1104584960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH WATERS PMHNP-BC

Provider Business Mailing Address
First Line	:	7121 CHARLESTON POINTE CT
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-2594
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 CHARLESTON POINTE CT
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-2594
Country	:	US
Telephone Number	:	251-332-7858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	03/10/2026

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