Provider Demographics
NPI:1558647099
Name:WATSON, AMY KRISTEN (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 LA TIERRA DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4613
Mailing Address - Country:US
Mailing Address - Phone:407-435-7770
Mailing Address - Fax:
Practice Address - Street 1:824 LA TIERRA DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4613
Practice Address - Country:US
Practice Address - Phone:407-435-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11159054174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN