Provider Demographics
NPI:1063212439
Name:WATSON, KRISTA LEIGH (RN, BSN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEIGH
Last Name:WATSON
Suffix:
Gender:
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HESSELRIDGE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-4401
Mailing Address - Country:US
Mailing Address - Phone:505-227-4338
Mailing Address - Fax:
Practice Address - Street 1:605 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2048
Practice Address - Country:US
Practice Address - Phone:254-900-7986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TX874079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach