Provider Demographics
NPI:1033855994
Name:WATSON, KENDRA VIVIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:VIVIAN
Last Name:WATSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KENDRA
Other - Middle Name:VIVIAN
Other - Last Name:PASKVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1501 N CAMPBELL AVE STE 4401
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5114
Mailing Address - Country:US
Mailing Address - Phone:520-626-7221
Mailing Address - Fax:520-626-7221
Practice Address - Street 1:1625 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4330
Practice Address - Country:US
Practice Address - Phone:520-626-7221
Practice Address - Fax:520-626-6943
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR3734207R00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine