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Individual

KATHY WATT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
930 BLUE STAR HWY, SOUTH HAVEN, MI 49090-7758
(269) 637-1115
Mailing address
930 BLUE STAR HWY, CLINIC BILLING DEPARTMENT, SOUTH HAVEN, MI 49090-7758
(269) 637-1115

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301007946
MI
207Q00000X
Family Medicine Physician
Primary
4704141333
MI
363LF0000X
Family Nurse Practitioner
4704141333
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
500D111330
BC/BS
MI
01
680C946400
BC/BS
MI
Enumeration date
06/09/2006
Last updated
09/15/2010
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