Provider Demographics
NPI:1730719352
Name:WATSON, ALISHA DEANN (FNP)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:DEANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76470-2054
Mailing Address - Country:US
Mailing Address - Phone:254-647-1182
Mailing Address - Fax:254-647-3133
Practice Address - Street 1:304 S DAUGHERTY AVE
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2609
Practice Address - Country:US
Practice Address - Phone:254-629-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily