Provider Demographics
NPI:1740997642
Name:WATSON, JACQUELYN (RT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W COURT SQ
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1882
Mailing Address - Country:US
Mailing Address - Phone:931-280-8202
Mailing Address - Fax:615-691-7141
Practice Address - Street 1:102 W COURT SQ
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1882
Practice Address - Country:US
Practice Address - Phone:931-280-8202
Practice Address - Fax:615-691-7141
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7594227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered