Provider Demographics
NPI:1356745418
Name:WATSON, RAKENDRA
Entity type:Individual
Prefix:MISS
First Name:RAKENDRA
Middle Name:
Last Name:WATSON
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 1:2000 SKYLINE DR
Mailing Address - Street 2:APT 827
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-1301
Mailing Address - Country:US
Mailing Address - Phone:504-914-6192
Mailing Address - Fax:
Practice Address - Street 1:2000 SKYLINE DR
Practice Address - Street 2:APT 827
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-1301
Practice Address - Country:US
Practice Address - Phone:504-914-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator