Basic Information
| Provider Information | |||||||||
| NPI: | 1154303626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATT | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 874 ED HALL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751421861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729325411 | ||||||||
| FaxNumber: | 9729325425 | ||||||||
| Practice Location | |||||||||
| Address1: | 874 ED HALL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751421861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729325411 | ||||||||
| FaxNumber: | 9729325425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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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 | 367A00000X | 741092 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1973406-02 | 05 | TX | MEDICAID | 00126113 | 05 | MS | MEDICAID | 569100057 | 05 | AL | MEDICAID | 730-14358 | 01 | BLUE CROSS OF AL | OTHER | MW1296284 | 01 | MS | DEA NUMBER | OTHER | 1973406-01 | 05 | TX | MEDICAID |