Provider Demographics
NPI:1518691302
Name:WATSON, KERRIN ROURKE (CNC, LE)
Entity Type:Individual
Prefix:
First Name:KERRIN
Middle Name:ROURKE
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNC, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3608
Mailing Address - Country:US
Mailing Address - Phone:415-254-9897
Mailing Address - Fax:
Practice Address - Street 1:1527 9TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3608
Practice Address - Country:US
Practice Address - Phone:415-254-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist