Provider Demographics
NPI:1992328991
Name:WATSON, KATHRYN KEYES
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KEYES
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAKE COUNTY HUMAN SERVICES
Mailing Address - Street 2:10 SUNNYBROOK ROAD, CLINIC B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-250-3999
Mailing Address - Fax:
Practice Address - Street 1:WAKE COUNTY HUMAN SERVICES
Practice Address - Street 2:10 SUNNYBROOK ROAD, CLINIC B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-250-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC232538163WE0003X
NC5013435363LA2200X
NCAG06200125363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner