Basic Information
| Provider Information | |||||||||
| NPI: | 1952842304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 MOUNTAIN STREET | ||||||||
| Address2: | FAMILY MEDICINE CENTER | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897030001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758821324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 MOUNTAIN ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758821324 | ||||||||
| FaxNumber: | 7758823859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2017 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 21836 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.