Individual provider Active NPI

Andria Katheryn Watson, NP, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Santa Cruz, CA
National Provider Identifier
1043728090
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95021939 Issued in CA
Practice address
1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone
(831) 454-4797
NPI assigned
Jan 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95021939 CA Primary

Addresses

Primary practice location

1400 Emeline Ave
Santa Cruz, CA 95060-1976

Mailing address

1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone (831) 454-4170

Other practice location 1

1430 Freedom Blvd Ste F
Watsonville, CA 95076-2752
Phone (831) 763-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230313001243 CA Practitioner - Nurse Practitioner 6507230620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa CruzGroup PAC ID 7618872912, 65 clinicians

Practice addresses (Care Compare)

1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone (831) 454-4971

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
95021939CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Cruz CurrentSince Nov 11, 2022 Accepting new patients
County of Santa Cruz CurrentSince Nov 11, 2022 Accepting new patients
South County Mental Health PastSince Oct 27, 2019 Accepting new patients

Locations

1400 Emeline Ave
Santa Cruz, CA 95060
Phone (831) 454-4900

1430 Freedom Blvd
Ste F
Watsonville, CA 95076
Phone (831) 588-7598

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1043728090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601976",
            "telephone_number": "831-454-4170",
            "fax_number": "831-454-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601976",
            "telephone_number": "831-454-4797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 Freedom Blvd Ste F",
            "address_purpose": "LOCATION",
            "city": "Watsonville",
            "state": "CA",
            "postal_code": "950762752",
            "country_code": "US",
            "telephone_number": "831-763-8200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "ANDRIA",
        "middle_name": "KATHERYN",
        "credential": "NP, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95021939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.