Basic Information
| Provider Information | |||||||||
| NPI: | 1619399169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 DINAH SHORE BLVD | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373981107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319676669 | ||||||||
| FaxNumber: | 9319676606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 DINAH SHORE BLVD | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373981107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319676669 | ||||||||
| FaxNumber: | 9319676606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2014 | ||||||||
| LastUpdateDate: | 04/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0114396 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.