Wallace Watts Jr., NP-C
Individual provider Active NPI Family Nurse Practitioner · Fabens, TX
NPI 1245772128 · NPPES record last updated Nov 21, 2023
Key facts
- NPI
- 1245772128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP132310 (TX)
- Practice address
- 101 Potasio Street
Fabens, TX 79838 - Phone
- (915) 790-5700
- NPI assigned
- Nov 9, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- El Paso County Hospital District
Practice addresses (Care Compare)
4815 Alameda Ave
El Paso, TX 79905-2705
Phone (915) 521-7902
4845 Alameda Ave
El Paso, TX 79905-2705
Phone (915) 298-5444
Hospital & facility affiliations
- University Medical Center of El Paso
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- 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 |
|---|---|---|---|---|
| I20170120001417 | TX | Practitioner - Nurse Practitioner | 7517249873 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP132310 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Paso County Hospital District | Current |
Accepting new patients | |
| El Paso County Hospital District | Current |
Accepting new patients | |
| Umc El Paso Healthcare Inc | Current |
Accepting new patients |
Locations
4500 N Mesa St
El Paso, TX 79912
Phone (915) 532-9000
4815 Alameda Ave
El Paso, TX 79905
Phone (915) 215-6000
Interoperability endpoints
- https://api.platform.athenahealth.com/24611/brand/1/csg/1/fhir/r4
- wallace.watts@direct.myhealthep.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP132310 | TX | Yes |
Addresses
Primary practice location
101 Potasio Street
Fabens, TX 79838
Mailing address
PO Box 202479
Dallas, TX 75320-2479
Phone (915) 790-5700
Other providers in Fabens, TX
All providers in Fabens, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2023. 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.