Provider Demographics
NPI:1275112203
Name:WATSON, KAYLEE LYNN
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:LYNN
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 W ANN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4407
Mailing Address - Country:US
Mailing Address - Phone:702-323-6555
Mailing Address - Fax:702-323-6613
Practice Address - Street 1:3850 W ANN RD STE 110
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4407
Practice Address - Country:US
Practice Address - Phone:702-323-6555
Practice Address - Fax:702-323-6613
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-21-161138106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician