MEDICARE: NICOLE AMY WATSON 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0996230-NP	CO

General Provider Information

NPI Number	:	1619569456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE AMY WATSON PMHNP-BC

Provider Business Mailing Address
First Line	:	5340 S QUEBEC ST STE 310S
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-1906
Country	:	US
Telephone Number	:	720-773-4771
Fax Number	:	720-414-1530

Provider Business Practice Location Address
First Line	:	5340 S QUEBEC ST STE 310S
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-1906
Country	:	US
Telephone Number	:	720-773-4771
Fax Number	:	720-414-1530

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	12/31/2025

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