1336308923 NPI number — DR. KIMBERLYN ROLANDA WATSON PH.D.

Table of content: DR. KIMBERLYN ROLANDA WATSON PH.D. (NPI 1336308923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336308923 NPI number — DR. KIMBERLYN ROLANDA WATSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
KIMBERLYN
Provider Middle Name:
ROLANDA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATSON
Provider Other First Name:
KIM
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336308923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 S CHAPEL ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-3467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-224-1400
Provider Business Mailing Address Fax Number:
302-526-2305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 S CHAPEL ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-224-1400
Provider Business Practice Location Address Fax Number:
302-526-2305
Provider Enumeration Date:
06/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  B10000776 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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