Provider Demographics
NPI:1598530685
Name:WATTERSON, NIKKI MICHELLE
Entity Type:Individual
Prefix:PROF
First Name:NIKKI
Middle Name:MICHELLE
Last Name:WATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8546 WILDLANE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-7792
Mailing Address - Country:US
Mailing Address - Phone:937-206-2137
Mailing Address - Fax:
Practice Address - Street 1:8546 WILDLANE DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-7792
Practice Address - Country:US
Practice Address - Phone:937-206-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant