Basic Information
| Provider Information | |||||||||
| NPI: | 1740786946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATTS | ||||||||
| FirstName: | CHARLOTTE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3261 RIVER LANDING DR | ||||||||
| Address2: | |||||||||
| City: | ADDIS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707102166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254214800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7479 PERKINS RD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252469997 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP09884 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2531379 | 05 | LA | MEDICAID |