Individual
MRS. DEITRA MECHELLE WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN-BC
Contact information
Practice address
1501 SUMTER ST, COLUMBIA, SC 29201-2829
(803) 296-3726
(803) 296-3460
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(865) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3842
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1528
—
SC
Enumeration date
05/15/2009
Last updated
04/07/2022
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