MEDICARE: DANIEL DEAN WATSON NP

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	363LF0000X	Family Nurse Practitioner	5010209	NC
2	208VP0000X	Pain Medicine Physician	5010209	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730687476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DEAN WATSON NP

Provider Business Mailing Address
First Line	:	645 N MAIN ST
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27260-5017
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:	336-883-0867

Provider Business Practice Location Address
First Line	:	1908 CAUDLE DR STE 100
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-4322
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:	336-883-0867

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

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	12/09/2021

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