Provider Demographics
NPI:1720732357
Name:WATSON, KIMBERLI
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLI
Other - Middle Name:
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20275 E RITTENHOUSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1661
Mailing Address - Country:US
Mailing Address - Phone:480-987-2053
Mailing Address - Fax:
Practice Address - Street 1:58-130 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9714
Practice Address - Country:US
Practice Address - Phone:480-987-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician