Provider Demographics
NPI:1093558850
Name:WATSON, SARA ALEXIS (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ALEXIS
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ALEXIS
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2204 PAVILION DR STE 108
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4651
Mailing Address - Country:US
Mailing Address - Phone:423-392-6100
Mailing Address - Fax:423-392-0803
Practice Address - Street 1:2204 PAVILION DR STE 108
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4651
Practice Address - Country:US
Practice Address - Phone:423-392-6100
Practice Address - Fax:423-392-0803
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36355OtherSTATE LICENSE NUMBER