Provider Demographics
NPI:1154446862
Name:WATT, KATHRYN C (NPC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:C
Last Name:WATT
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CONNELL RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1407
Mailing Address - Country:US
Mailing Address - Phone:229-244-4720
Mailing Address - Fax:229-247-1084
Practice Address - Street 1:410 CONNELL RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1407
Practice Address - Country:US
Practice Address - Phone:229-244-4720
Practice Address - Fax:229-247-1084
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily