Provider Demographics
NPI:1548962384
Name:WATSON, LINDA KAY (CHW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:WATSON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OR
Mailing Address - Zip Code:97865-0643
Mailing Address - Country:US
Mailing Address - Phone:541-620-0444
Mailing Address - Fax:
Practice Address - Street 1:235 S CANYON BLVD
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1044
Practice Address - Country:US
Practice Address - Phone:541-575-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR107065172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker