Provider Demographics
NPI:1275116816
Name:WATSON, BEVERLY SHARON
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SHARON
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 1:211 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5615
Mailing Address - Country:US
Mailing Address - Phone:928-293-1884
Mailing Address - Fax:
Practice Address - Street 1:211 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5615
Practice Address - Country:US
Practice Address - Phone:928-293-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist