Provider Demographics
NPI:1710703269
Name:VARNEY, WATTA KIMBERLYN
Entity type:Individual
Prefix:
First Name:WATTA
Middle Name:KIMBERLYN
Last Name:VARNEY
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 1:500 CHEYNEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1805
Mailing Address - Country:US
Mailing Address - Phone:215-313-0893
Mailing Address - Fax:
Practice Address - Street 1:500 CHEYNEY RD
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1805
Practice Address - Country:US
Practice Address - Phone:215-313-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily