Provider Demographics
NPI:1427845502
Name:WATSON, MARY ANN (RDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MOON SHADOW
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5094
Mailing Address - Country:US
Mailing Address - Phone:609-369-9299
Mailing Address - Fax:
Practice Address - Street 1:720 MOON SHADOW
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5094
Practice Address - Country:US
Practice Address - Phone:609-369-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
918392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered