Provider Demographics
NPI:1194556035
Name:WATSON, SHELBY JERENE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JERENE
Last Name:WATSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JERENE
Other - Last Name:LOVEGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP, FNP
Mailing Address - Street 1:4815 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2705
Mailing Address - Country:US
Mailing Address - Phone:915-521-7414
Mailing Address - Fax:915-521-2235
Practice Address - Street 1:1393 GEORGE DIETER DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7410
Practice Address - Country:US
Practice Address - Phone:915-231-2381
Practice Address - Fax:915-231-2382
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048314363LP2300X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty