Provider Demographics
NPI:1043256373
Name:WATTS, CAROLYN BEA (CRNA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:BEA
Last Name:WATTS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 N MACARTHUR BLVD
Mailing Address - Street 2:STE. 220
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2617
Mailing Address - Country:US
Mailing Address - Phone:972-714-0007
Mailing Address - Fax:972-714-0009
Practice Address - Street 1:5605 N MACARTHUR BLVD
Practice Address - Street 2:STE. 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2617
Practice Address - Country:US
Practice Address - Phone:972-714-0007
Practice Address - Fax:972-714-0009
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX542681367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405535700Medicaid
TX204721905Medicaid
TX204721904Medicaid
MD405535700Medicaid
TXTXB119025Medicare PIN
TX204721904Medicaid