Provider Demographics
NPI:1730635574
Name:WATSON, KEVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-0100
Mailing Address - Fax:515-358-0109
Practice Address - Street 1:1111 6TH AVENUE
Practice Address - Street 2:EAST TOWER, SUITE B1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-358-0100
Practice Address - Fax:515-358-0109
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant