Provider Demographics
NPI:1639589773
Name:WATSON, KIMBERLY LA'DAWN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LA'DAWN
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LA'DAWN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2010 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4406
Mailing Address - Country:US
Mailing Address - Phone:937-241-5638
Mailing Address - Fax:
Practice Address - Street 1:2132 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1991
Practice Address - Country:US
Practice Address - Phone:397-528-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-C F0414012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily