Provider Demographics
NPI:1588628721
Name:WATSON, JAMES KRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KRIS
Last Name:WATSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1442
Mailing Address - Country:US
Mailing Address - Phone:704-797-0065
Mailing Address - Fax:704-797-0067
Practice Address - Street 1:320 JAKE ALEXANDER BLVD W
Practice Address - Street 2:SUITE 103
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1442
Practice Address - Country:US
Practice Address - Phone:704-797-0065
Practice Address - Fax:704-797-0067
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103446363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP53116Medicare UPIN
2754767Medicare ID - Type Unspecified