Provider Demographics
NPI:1245913623
Name:WATTS, YAKISHA CARAVELLE (NURSE)
Entity type:Individual
Prefix:
First Name:YAKISHA
Middle Name:CARAVELLE
Last Name:WATTS
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PINE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3251
Mailing Address - Country:US
Mailing Address - Phone:864-567-6046
Mailing Address - Fax:864-991-8893
Practice Address - Street 1:44 PINE KNOLL DR STE K
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3257
Practice Address - Country:US
Practice Address - Phone:864-991-8856
Practice Address - Fax:864-991-8893
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44506164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse