Provider Demographics
NPI:1902279680
Name:WATSON, KENYA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KENYA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 RALPH MCGILL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1227
Mailing Address - Country:US
Mailing Address - Phone:678-321-6427
Mailing Address - Fax:
Practice Address - Street 1:375 RALPH MCGILL BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1227
Practice Address - Country:US
Practice Address - Phone:678-321-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA215051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily