Provider Demographics
NPI:1013778679
Name:WATTS, KIMBERLY L
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:WATTS
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 1:209 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1760
Mailing Address - Country:US
Mailing Address - Phone:856-214-6967
Mailing Address - Fax:
Practice Address - Street 1:209 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1760
Practice Address - Country:US
Practice Address - Phone:856-214-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor