Provider Demographics
NPI:1285478099
Name:WATERS, TIMMIE TYRONE
Entity type:Individual
Prefix:
First Name:TIMMIE
Middle Name:TYRONE
Last Name:WATERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 SANDY POINT RD APT 4206
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-8214
Mailing Address - Country:US
Mailing Address - Phone:979-383-3481
Mailing Address - Fax:
Practice Address - Street 1:1828 SANDY POINT RD APT 4206
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-8214
Practice Address - Country:US
Practice Address - Phone:979-383-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty