Provider Demographics
NPI:1639908320
Name:WATSON, JESSIKA SKYE
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:SKYE
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 1:500 S COLLEGE AVE UNIT 55
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-0902
Mailing Address - Country:US
Mailing Address - Phone:509-540-7759
Mailing Address - Fax:
Practice Address - Street 1:780 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3524
Practice Address - Country:US
Practice Address - Phone:509-942-3070
Practice Address - Fax:509-942-3167
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60761070163WU0100X
MNA01124103363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No163WU0100XNursing Service ProvidersRegistered NurseUrology