Provider Demographics
NPI:1437873106
Name:WATSON, KATHRYN (LPN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3123
Mailing Address - Country:US
Mailing Address - Phone:740-450-7790
Mailing Address - Fax:
Practice Address - Street 1:317 HIGHLAND AVE # AVW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2529
Practice Address - Country:US
Practice Address - Phone:740-435-9766
Practice Address - Fax:740-432-4966
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH131602164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No164W00000XNursing Service ProvidersLicensed Practical Nurse