NPI |
1598120511 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Entity Type Code |
1 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Last Name Legal Name |
WATT |
The city name in the location address of the provider being identified. |
Provider First Name |
MELANIE |
The State code in the location of the provider
being identified. |
Provider Middle Name |
R |
The middle name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
DR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider Credential Text |
PSY.D, BCB |
The telephone number associated with the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
10791 KITTY DR |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
CONIFER |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address State Name |
CO |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Postal Code |
804337747 |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
7206893440 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
12/17/2015 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
1/18/2023 |
|
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
103T00000X |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Provider License Number 1 |
PS018172 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
PA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
1/18/2023 |
|