Individual
IAN WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-5220
(903) 614-1000
Mailing address
5410 MARYLAND WAY STE 300, BRENTWOOD, TN 37027-5339
(615) 377-1705
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP141005
TX
363L00000X
Nurse Practitioner
CNP211618
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP141005
STATE LICENSE
TX
Enumeration date
03/18/2019
Last updated
02/13/2022
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