Provider Demographics
NPI:1194252635
Name:WATSON, MONISE L
Entity type:Individual
Prefix:
First Name:MONISE
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:OK
Mailing Address - Zip Code:74533-0072
Mailing Address - Country:US
Mailing Address - Phone:580-513-0919
Mailing Address - Fax:580-509-5041
Practice Address - Street 1:321 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2047
Practice Address - Country:US
Practice Address - Phone:580-239-2071
Practice Address - Fax:580-509-5041
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator