Provider Demographics
NPI:1699710657
Name:WATSON, ELIZABETH M (PMH-NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5808
Mailing Address - Country:US
Mailing Address - Phone:910-692-2444
Mailing Address - Fax:910-692-3031
Practice Address - Street 1:195 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5808
Practice Address - Country:US
Practice Address - Phone:910-692-2444
Practice Address - Fax:910-692-3031
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-03028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078455OtherRN LICENSE
NC142373OtherNCMB CERT OF REGISTRATION
NC6004006Medicaid
NC2596192MMedicare ID - Type Unspecified
S64924Medicare UPIN