Provider Demographics
NPI:1396465779
Name:WATTS, KELSEY CHEYENNE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CHEYENNE
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 1:5514 GRIGGS RD APT 1830
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3769
Mailing Address - Country:US
Mailing Address - Phone:281-512-9079
Mailing Address - Fax:
Practice Address - Street 1:7747 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4309
Practice Address - Country:US
Practice Address - Phone:281-512-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program