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General NPI Number Information
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NPI Number | 1417031733
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Entity Type | Individual
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Provider Name | KATHRYN S WATSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 5734 COVENTRY LN
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City | FORT WAYNE
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State | IN
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Zip | 46804-7141
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Country | US
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Telephone | 260-436-7875
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Fax |
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Provider Business Mailing Address
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Address Line | 5052 N CLINTON ST
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City | FORT WAYNE
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State | IN
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Zip | 46825-5822
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Country | US
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Telephone | 260-408-2203
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Fax | 260-408-8014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 160617
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28145281A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA-03760
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License Number State | OH
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