# MR. JEROME BRADFIELD WATSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1538162045
- **Gender:** Man
- **Credential:** GNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | AP108606 | TX | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | 605190 | TX | — |

## Other

- **Enumeration date:** 05/30/2005
- **Last updated:** 08/02/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 029325001 | — | TX |
| 05 | — | 029325002 | — | TX |
| 05 | — | 100082540A | — | OK |
| 05 | — | 145430758 | — | AR |
| 05 | — | 160262762 | — | AR |
| 05 | — | 29325004 | — | TX |
| 01 | — | 500004259 | RAILROAD MEDICARE | AR |
| 01 | — | 500004259 | RAILROAD MEDICARE | TX |
| 01 | — | 5U081 | MEDICARE - LEGACY NUMBER | AR |
| 01 | — | 8D9579 | MEDICARE - LEGACY NUMBER | TX |
| 01 | — | P00267929 | TX RAILROAD MEDICARE | TX |