Provider Demographics
NPI:1760637920
Name:WATSON, KENDRA JAYNE (FNP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:JAYNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:LAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 NW LOVEJOY ST
Mailing Address - Street 2:#432
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2734
Mailing Address - Country:US
Mailing Address - Phone:503-914-6125
Mailing Address - Fax:
Practice Address - Street 1:1420 NW LOVEJOY ST
Practice Address - Street 2:#432
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2734
Practice Address - Country:US
Practice Address - Phone:503-914-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950096NP363LF0000X
OR200541430RN163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency