Provider Demographics
NPI:1487309845
Name:WATSON, KASEY DALE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:DALE
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7340
Mailing Address - Country:US
Mailing Address - Phone:919-862-5971
Mailing Address - Fax:
Practice Address - Street 1:3404 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7340
Practice Address - Country:US
Practice Address - Phone:919-862-5971
Practice Address - Fax:919-862-5227
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015644208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty