Provider Demographics
NPI:1548804990
Name:WATSON, CHELSEY KRISTYN (CNP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:KRISTYN
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 RED ROCK CANYON RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4869
Mailing Address - Country:US
Mailing Address - Phone:605-680-2975
Mailing Address - Fax:
Practice Address - Street 1:4447 S CANYON RD STE 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1889
Practice Address - Country:US
Practice Address - Phone:605-721-6426
Practice Address - Fax:605-721-5515
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily