Provider Demographics
NPI:1487642211
Name:WATSON, FAYE ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LENAPE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048
Mailing Address - Country:US
Mailing Address - Phone:918-273-7545
Mailing Address - Fax:918-273-2147
Practice Address - Street 1:1020 LENAPE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048
Practice Address - Country:US
Practice Address - Phone:918-273-0192
Practice Address - Fax:918-273-2147
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered