Provider Demographics
NPI:1295213643
Name:WATSON, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
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 1:1300 S DAWN DR
Mailing Address - Street 2:
Mailing Address - City:MILLIKEN
Mailing Address - State:CO
Mailing Address - Zip Code:80543-8447
Mailing Address - Country:US
Mailing Address - Phone:970-888-1216
Mailing Address - Fax:
Practice Address - Street 1:1300 S DAWN DR
Practice Address - Street 2:
Practice Address - City:MILLIKEN
Practice Address - State:CO
Practice Address - Zip Code:80543-8447
Practice Address - Country:US
Practice Address - Phone:970-888-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO921183247347C00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$OtherSOCIAL SECURITY CARD