Provider Demographics
NPI:1326530957
Name:RIDER WATSON, MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:RIDER WATSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HENKE CV
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4636
Mailing Address - Country:US
Mailing Address - Phone:512-897-9808
Mailing Address - Fax:
Practice Address - Street 1:121 HENKE CV
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4636
Practice Address - Country:US
Practice Address - Phone:512-897-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX847068163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics