Deitra Mechelle Watson, MSN, APRN-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3842 Issued in SC

Practice address

1501 Sumter St
Columbia, SC 29201-2829

Phone

(803) 296-3726

Fax

(803) 296-3460

NPI assigned

May 15, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Master of Science - Nursing

State licenses

Practice roles

Locations

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.

• Prisma Health Medical Group-Midlands

  • Multi-Specialty Clinic/Center
  • Columbia, SC
  • NPI 1275988321
  Medicare reassignment NPD
• Prisma Health Medical Group-Midlands

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1881469856
  NPD

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1285869578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "865-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SUMTER ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012829",
            "telephone_number": "803-296-3726",
            "fax_number": "803-296-3460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1853 Greenwyche Ave",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292106123",
            "country_code": "US",
            "telephone_number": "803-731-0069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "DEITRA",
        "middle_name": "MECHELLE",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-15",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "3842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1528",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Claire Watson, LPC, M.A.
• Ashley Watson
• Asia Watson
• Carol Hart Watson, LPC
• Christopher Madison Watson, M.D.
• Edwin Selman Watson, PH.D.
• Herman William Watson Jr., PHARMACIST
• Jacqueline Watson
• Jessica Leigh Watson, MD
• Kasey Watson, OT

• Family Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; 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.