Provider Demographics
NPI:1801688270
Name:WATSON, KENISHA ANDRAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KENISHA
Middle Name:ANDRAH
Last Name:WATSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1041
Mailing Address - Country:US
Mailing Address - Phone:267-721-5782
Mailing Address - Fax:
Practice Address - Street 1:641 N 13TH ST STE E-101
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1430
Practice Address - Country:US
Practice Address - Phone:908-722-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO32792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health