Basic Information
| Provider Information | |||||||||
| NPI: | 1134245343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN-WATSON | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1978 WACCAMAW PATH | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271279433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363915701 | ||||||||
| FaxNumber: | 3367711641 | ||||||||
| Practice Location | |||||||||
| Address1: | 2645 MERIDIAN PKWY STE 323 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277134232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9842278902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 075746 | NC | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 102293 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | 900278 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 170XN | 01 | NC | BCBS | OTHER | 7006380 | 05 | NC | MEDICAID | 6113029 | 01 | NC | MEDICAID NC - BEHAVORIAL HEALTH | OTHER |