Individual
DIA WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2010 ACTIVE WAY, BRYANT, AR 72022-9267
(501) 315-0984
(501) 847-1405
Mailing address
2010 ACTIVE WAY, BENTON, AR 72022-9267
(501) 315-0984
(501) 847-1405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA540
AR
363AM0700X
Medical Physician Assistant
PA-540
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA540
ARKANSAS STATE MEDICAL LICENSE
AR
Enumeration date
02/18/2014
Last updated
06/16/2018
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