Provider Demographics
NPI:1417626177
Name:WATTS, MCKENZIE S (RN)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:S
Last Name:WATTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MCKENIZE
Other - Middle Name:S
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:560 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 22ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4408
Practice Address - Country:US
Practice Address - Phone:541-653-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201605291163WM0705X
OR201605291RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical