Provider Demographics
NPI:1932772019
Name:WATSON, KAREN ANNE (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-0447
Mailing Address - Country:US
Mailing Address - Phone:585-245-4377
Mailing Address - Fax:
Practice Address - Street 1:42 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-9405
Practice Address - Country:US
Practice Address - Phone:585-245-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403562363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY403562OtherNP