Jennifer Rose Watry, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5013 Issued in AZ

Practice address

9735 N 90TH PL
Scottsdale, AZ 85258

Phone

(480) 222-4954

Fax

(602) 297-6556

NPI assigned

Dec 5, 2011

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1295003374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9735 N 90TH PL",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852585067",
            "telephone_number": "480-222-4954",
            "fax_number": "602-297-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9735 N 90TH PL",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85258",
            "telephone_number": "480-222-4954",
            "fax_number": "602-297-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATRY",
        "first_name": "JENNIFER",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-05",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "5013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberely Ann Waters
• Lisa Waters
• Watershed Financial, LLC
• Angela Watkins
• Lindsey Marie Watkins, MA-CCC SLP
• Christine M Watson, PT CHT
• Edie Watson, DNP, WHNP
• Linda Lucky Watson X, RN
• Mackenzie Watson, CRNA
• Spencer Watson, PA

• Surgical Physician Assistant in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; 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.