MEDICARE: JACQUELINE WATSON ANP-C

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	363LA2200X	Adult Health Nurse Practitioner	671036	TX

General Provider Information

NPI Number	:	1467765081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE WATSON ANP-C

Provider Business Mailing Address
First Line	:	4102 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4808
Country	:	US
Telephone Number	:	713-524-2633
Fax Number	:	713-524-2639

Provider Business Practice Location Address
First Line	:	4102 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4808
Country	:	US
Telephone Number	:	713-524-2633
Fax Number	:	713-524-2639

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

Provider Enumeration Date	:	07/24/2010
Last Update Date	:	07/26/2021

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