Active NPI
Mirrisha Watson
- Family Nurse Practitioner
- Fuquay Varina, NC
National Provider Identifier
1760118566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- WATS-VB04G
- Practice address
- 409 Wake Chapel Rd
Fuquay Varina, NC 27526-1956 - Phone
- (919) 514-1740
- NPI assigned
- Jul 26, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | WATS-VB04G | NC | Primary |
Addresses
Primary practice location
409 Wake Chapel Rd
Fuquay Varina, NC 27526-1956
Mailing address
5139 Sandy Banks Rd
Raleigh, NC 27616-8427
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WATS-VB04G | NC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658793600000",
"number": "1760118566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5139 SANDY BANKS RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276168427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 WAKE CHAPEL RD",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275261956",
"telephone_number": "919-514-1740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "MIRRISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-26",
"last_updated": "2022-07-26",
"certification_date": "2022-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NC",
"license": "WATS-VB04G",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.