MEDICARE: KEYONNA WATSON FNP-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	363LF0000X	Family Nurse Practitioner	AP134795	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP134795	OTHER	TX	TEXAS BON

General Provider Information

NPI Number	:	1821513037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYONNA WATSON FNP-C

Provider Business Mailing Address
First Line	:	3718 SPRING CT
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 N TEXAS AVE STE 4100
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4964
Country	:	US
Telephone Number	:	281-317-1261
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	08/08/2017

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