Individual provider Active NPI

Stephanie Marie Watson

  • Physician Assistant
  • Cary, NC
National Provider Identifier
1467002634
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-15352 Issued in NC
Practice address
720 Fenton Market Way Ste 140
Cary, NC 27511-7750
Phone
(888) 663-6331
Fax
(415) 252-7176
NPI assigned
Sep 18, 2019
Last updated
Jul 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA200001296 DC
Physician Assistant 363A00000X 4595 CT
Medical Physician Assistant 363AM0700X 4595 CT
Physician Assistant 363A00000X 0010-15352 NC Primary

Addresses

Primary practice location

720 Fenton Market Way Ste 140
Cary, NC 27511-7750

Mailing address

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723
Phone (415) 658-6791

Other practice location 1

21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500

Other practice location 2

1350 Connecticut Ave NW Ste 1250
Washington, DC 20036-1728
Phone (202) 627-1901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220119000005 DC Practitioner - Physician Assistant 7113352667 Reassigns benefits to 1 organization
I20250730000504 NC Practitioner - Physician Assistant 7113352667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wake Forest University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1901 Hillandale Rd
Durham, NC 27705-2664

720 Fenton Market Way
Suite 140
Cary, NC 27511-7750
Phone (888) 663-6331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4595CTMDOral and Maxillofacial Surgery (Dentist)
PA200001296DCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. CurrentSince Jul 21, 2025 Accepting new patients
Duke University Affiliated Physicians, Inc. CurrentSince Jul 21, 2025 Accepting new patients
Duke University Affiliated Physicians, Inc. Past Accepting new patients

Locations

720 Fenton Market Way
Ste 140
Cary, NC 27511

1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1467002634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723",
            "telephone_number": "415-658-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 FENTON MARKET WAY STE 140",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117750",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Grand St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061061541",
            "country_code": "US",
            "telephone_number": "860-550-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1350 Connecticut Ave NW Ste 1250",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200361728",
            "country_code": "US",
            "telephone_number": "202-627-1901",
            "fax_number": "415-252-7176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-18",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA200001296",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4595",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "4595",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.