Provider Demographics
NPI:1194567453
Name:WATSON, JESSICA ANNE (DACCHM, LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:DACCHM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 W C ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-9349
Mailing Address - Country:US
Mailing Address - Phone:828-489-2031
Mailing Address - Fax:
Practice Address - Street 1:2206 W C ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-9349
Practice Address - Country:US
Practice Address - Phone:828-489-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist