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NPI Code Detail

MEDICARE: MRS. KIMBERLY LA'DAWN WATSON CNP

MEDICARE: MRS. KIMBERLY LA'DAWN WATSON CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerNP-C F0414012OH

General Provider Information

NPI Number : 1639589773
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY LA'DAWN WATSON CNP
Provider Business Mailing Address
First Line : 2010 BENSON DR
Second Line :
City : DAYTON
State : OH
Zip : 45406-4406
Country : US
Telephone Number : 937-241-5638
Fax Number :
Provider Business Practice Location Address
First Line : 2132 E 3RD ST
Second Line :
City : DAYTON
State : OH
Zip : 45403-1991
Country : US
Telephone Number : 397-528-6850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2014
Last Update Date : 02/28/2024

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