Provider Demographics
NPI:1326655960
Name:WATTERSON, TARSHEIMA RENEE
Entity Type:Individual
Prefix:
First Name:TARSHEIMA
Middle Name:RENEE
Last Name:WATTERSON
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:PO BOX 7028
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0197
Mailing Address - Country:US
Mailing Address - Phone:304-809-1343
Mailing Address - Fax:
Practice Address - Street 1:179 THOR LN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-8733
Practice Address - Country:US
Practice Address - Phone:304-809-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant