Provider Demographics
NPI:1346477189
Name:WATSON, KATHLEEN R (FNP B-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP B-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 PAXON RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9408
Mailing Address - Country:US
Mailing Address - Phone:716-992-9579
Mailing Address - Fax:
Practice Address - Street 1:124 A BOARDWALK DRIVE
Practice Address - Street 2:RECOVERY CONCEPTS LLC
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936
Practice Address - Country:US
Practice Address - Phone:843-645-2770
Practice Address - Fax:843-645-2771
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335932363LF0000X
GA282122363LF0000X
SC22556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily