Healthcare Provider Details

I. General information

NPI: 1285734103
Provider Name (Legal Business Name): KIRK WATSON HS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST SUITE 1000
NORFOLK VA
23510-1753
US

IV. Provider business mailing address

300 E MAIN ST SUITE 1000
NORFOLK VA
23510-1753
US

V. Phone/Fax

Practice location:
  • Phone: 757-628-4375
  • Fax: 757-628-4355
Mailing address:
  • Phone: 757-628-4375
  • Fax: 757-628-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: