Healthcare Provider Details

I. General information

NPI: 1609235373
Provider Name (Legal Business Name): KIM WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 STAR REEF LN
EDGEWATER FL
32132-6947
US

IV. Provider business mailing address

2500 NW 29TH MNR
POMPANO BEACH FL
33069-1031
US

V. Phone/Fax

Practice location:
  • Phone: 386-292-6165
  • Fax:
Mailing address:
  • Phone: 855-488-4875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9275164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: