Trenton Watson, NP
Individual provider Active NPI Nurse Practitioner · Smiths Station, AL
NPI 1215475306 · NPPES record last updated Feb 8, 2017
Key facts
- NPI
- 1215475306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 1-107743 (AL)
- Practice address
- 533 Shadow Wood Dr
Smiths Station, AL 36877-4836 - Phone
- (850) 814-4107
- NPI assigned
- Feb 8, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Nexus Pain Center of Columbus LLC
Practice addresses (Care Compare)
7351 Old Moon Rd
Columbus, GA 31909-7291
Phone (706) 653-7000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171004002238 | GA | Practitioner - Nurse Practitioner | 1557636362 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-107743 | AL | MD | Nurse Practitioner |
| 244202 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tift Regional Health System Inc. | Current |
Accepting new patients | |
| Tift Regional Health System Inc | Current |
Accepting new patients |
Locations
901 18th St E
Tifton, GA 31794
Phone (229) 353-6208
1622 Madison Ave
Tifton, GA 31794
Phone (229) 387-8061
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 244202 | GA | |
| Nurse Practitioner | 363L00000X | 1-107743 | AL | Yes |
Addresses
Primary practice location
533 Shadow Wood Dr
Smiths Station, AL 36877-4836
Mailing address
533 Shadow Wood Dr
Smiths Station, AL 36877-4836
Phone (850) 814-4107
Other providers in Smiths Station, AL
- Smiths Station Fire and Rescue
- Smiths Station Pharmacy LLC
- Kenya Spencer
- Stonecreek Acquisitions, LLC
- Nursie Mae Thomas
- Kenya Denise Whitehorn
- Linda Williams
- Lennie Cole Wright
- Dorothea Yates
All providers in Smiths Station, AL · Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.