Provider Demographics
NPI:1326670514
Name:WATSON, CHIE KASHIZUKA (FNP)
Entity Type:Individual
Prefix:
First Name:CHIE
Middle Name:KASHIZUKA
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 SAN PEDRO AVE # 316
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6219
Mailing Address - Country:US
Mailing Address - Phone:210-745-0084
Mailing Address - Fax:210-745-0139
Practice Address - Street 1:15102 JONES MALTSBERGER RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3367
Practice Address - Country:US
Practice Address - Phone:210-745-0084
Practice Address - Fax:210-745-0139
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily