Individual
TARA WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
4219 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3410
(405) 644-5200
Mailing address
2616 NW 27TH ST, OKLAHOMA CITY, OK 73107-2104
(405) 740-1186
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA823
OK
Other
Enumeration date
06/15/2010
Last updated
06/15/2010
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