Basic Information
| Provider Information | |||||||||
| NPI: | 1366431777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATTERS | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 FAUNCE CORNER RD | ||||||||
| Address2: | SOUTHCOAST PRIMARY CARE INC | ||||||||
| City: | N DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027471271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089852000 | ||||||||
| FaxNumber: | 5089852001 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 STATE RD | ||||||||
| Address2: | NAUSET BLDG- SOUTHCOAST PRIMARY CARE INC | ||||||||
| City: | N DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027473322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089912255 | ||||||||
| FaxNumber: | 5089990387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 234382 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.