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General NPI Number Information
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NPI Number | 1477449304
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Entity Type | Individual
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Provider Name | MONIQUE WATSON
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Gender | Female
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 12202 BROOKGREEN DR
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City | LOUISVILLE
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State | KY
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Zip | 40243-2106
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Country | US
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Telephone | 502-322-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 12123 SHELBYVILLE RD STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40243-1079
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Country | US
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Telephone | 502-322-0712
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Fax |
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 1152723
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License Number State | KY
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