Provider Demographics
NPI:1922684612
Name:WATSON, ALEXIS JEANLEFON (LPN)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:JEANLEFON
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 159TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-7417
Mailing Address - Country:US
Mailing Address - Phone:253-472-2153
Mailing Address - Fax:
Practice Address - Street 1:8803 TERRACE RD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4659
Practice Address - Country:US
Practice Address - Phone:235-844-4523
Practice Address - Fax:235-302-3923
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00046252164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA239541Medicaid