Watsons Family Medical Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

WATSONS FAMILY MEDICAL CLINIC

Practice address

1418 McCoy Dr
Harrison, AR 72601-2411

Phone

(870) 208-1037

Fax

(870) 391-2299

NPI assigned

May 20, 2019

Organization subpart

No

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

Authorized official

Name

Fanae Watson, FNP-CNPI 1417315318

Title

Owner/Provider

Phone

(870) 280-1037

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fanae Watson, NP

  • Family Nurse Practitioner
  • Harrison, AR
  • NPI 1417315318
  Medicare reassignment Authorized official
• Heather Tina McCutcheon, MHPP

  • Case Manager/Care Coordinator
  • Harrison, AR
  • NPI 1053534370
  NPD

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1790341303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 MCCOY DR",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726012411",
            "telephone_number": "870-280-1037",
            "fax_number": "870-391-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 MCCOY DR",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726012411",
            "telephone_number": "870-208-1037",
            "fax_number": "870-391-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATSONS FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-20",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "FANAE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "870-280-1037",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Washington Regional Medical System (Crossroads Medical Clinic - Washington Regional)
• Washington Regional Medical System (Harrison Family Practice Clinic - Washington Regional)
• James D Waters, MD
• Mattie Elizabeth Watkins
• Fanae Watson, NP
• Judy Wharff, MHPP
• Jeffrey Zack Wheeler, PHARMD
• John Matthew White
• Shaleena Rae White
• Toshia R Whiteside

• Primary Care Clinic/Center in Harrison, AR
• Providers in Harrison, AR by specialty
• Primary Care Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.