Individual
MR. JEROME BRADFIELD WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
GNP
Contact information
Practice address
7209 GOLDFINCH RD, TEXARKANA, TX 75501-0227
(903) 334-8132
(903) 334-8146
Mailing address
7209 GOLDFINCH RD, TEXARKANA, TX 75501-0227
(903) 334-8132
(903) 334-8146
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP108606
TX
363LG0600X
Gerontology Nurse Practitioner
605190
TX
Other
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
Enumeration date
05/30/2005
Last updated
08/02/2024
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