Provider Demographics
NPI:1740623776
Name:WATSON, KENDRA D (MD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:D
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:605-330-9619
Mailing Address - Fax:605-330-9503
Practice Address - Street 1:4950 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2864
Practice Address - Country:US
Practice Address - Phone:605-330-9619
Practice Address - Fax:605-330-9503
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10433207N00000X
SD0079390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology