Healthcare Provider Details

I. General information

NPI: 1659312809
Provider Name (Legal Business Name): KATHY WATT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12226 FELCH ST
HOLLAND MI
49424-9676
US

IV. Provider business mailing address

31 DELAWARE CT
SOUTH HAVEN MI
49090-1642
US

V. Phone/Fax

Practice location:
  • Phone: 269-455-1110
  • Fax:
Mailing address:
  • Phone: 269-744-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007946
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704141333
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4704141333
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: