Provider Demographics
NPI:1861706764
Name:WATTS, KAREN STEPHENSON
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:STEPHENSON
Last Name:WATTS
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 1:841 OLD WINSTON RD
Mailing Address - Street 2:STE 90
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7144
Mailing Address - Country:US
Mailing Address - Phone:336-497-4511
Mailing Address - Fax:336-497-4511
Practice Address - Street 1:841 OLD WINSTON RD
Practice Address - Street 2:STE 90
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7144
Practice Address - Country:US
Practice Address - Phone:336-497-4511
Practice Address - Fax:336-497-4511
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0347780Medicaid