Mary Jo Watterson, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5012779 Issued in NC

Practice address

2511 Old Cornwallis Rd Ste 200
Durham, NC 27713-1869

Phone

(919) 932-5700

NPI assigned

Jan 29, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1235760166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W 18TH ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283584514",
            "telephone_number": "910-258-9467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 OLD CORNWALLIS RD STE 200",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277131869",
            "telephone_number": "919-932-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTERSON",
        "first_name": "MARY",
        "middle_name": "JO",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14612409",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Eclinicalworks",
            "affiliation": "N",
            "endpointDescription": "Electronic Medical Record",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2511 Old Cornwallis Rd Ste 200",
            "city": "Durham",
            "state": "NC",
            "country_code": "US",
            "postal_code": "277131869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Eclinical",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2511 Old Cornwallis Rd Ste 200",
            "city": "Durham",
            "state": "NC",
            "country_code": "US",
            "postal_code": "277131869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Eclinicalworks",
            "affiliation": "N",
            "address_1": "2511 Old Cornwallis Rd Ste 200",
            "city": "Durham",
            "state": "NC",
            "country_code": "US",
            "postal_code": "277131869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rachel Watson
• Tamrah Joy Watson, FNP-C
• Tomeika Simmons Watson
• Virginia Blair Watson, MPT
• Kevin Michael Watt, M.D.
• Maggie Watts, MSW, LCSWA
• Courtney Ann Waugaman, FNP-C
• Katy Ann Waugh, MS, CCC-SLP
• Michael Stuart Waugh, MD
• Joseph Richard Wawrzynski

• Nurse Practitioner in Durham, NC
• Providers in Durham, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.