MEDICARE: MISS KIONDRA WATSON LMBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	20191	NC

General Provider Information

NPI Number	:	1720856669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIONDRA WATSON LMBT

Provider Business Mailing Address
First Line	:	8416 LARKMEAD FOREST DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1154
Country	:	US
Telephone Number	:	213-290-6167
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 ALBEMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6617
Country	:	US
Telephone Number	:	213-290-6167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	03/03/2026

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