Provider Demographics
NPI:1861993784
Name:WATSON, DEEANNA LYNNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:DEEANNA
Middle Name:LYNNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4013
Mailing Address - Country:US
Mailing Address - Phone:409-384-3430
Mailing Address - Fax:
Practice Address - Street 1:315 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4013
Practice Address - Country:US
Practice Address - Phone:409-384-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660779163WP0200X
TX1032244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics