Healthcare Provider Details

I. General information

NPI: 1265094973
Provider Name (Legal Business Name): JENNIFER ROBINSON WATSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FAIRVIEW DR STE B
FRANKLIN VA
23851-1206
US

IV. Provider business mailing address

PO BOX 639972
CINCINNATI OH
45263-9972
US

V. Phone/Fax

Practice location:
  • Phone: 757-562-2158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024177814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: