Sierra Watson

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6906883 Issued in FL

Legal business name

SIERRA WATSON

Practice address

12610 US Highway 129
Live Oak, FL 32060-6753

Phone

(678) 886-1384

Fax

(386) 208-0002

NPI assigned

Mar 16, 2017

Organization subpart

No

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

Authorized official

Name

Sierra Watson

Title

Administrator/Owner

Phone

(678) 886-1384

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1356882898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12610 US HIGHWAY 129",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320606753",
            "telephone_number": "678-886-1384",
            "fax_number": "386-208-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12610 US HIGHWAY 129",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320606753",
            "telephone_number": "678-886-1384",
            "fax_number": "386-208-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA WATSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-16",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "SIERRA",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "678-886-1384"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6906883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019424000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Live Oak, FL
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• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.