Provider Demographics
NPI:1053894741
Name:WATSON, DENEQUA SHIRNEK
Entity type:Individual
Prefix:
First Name:DENEQUA
Middle Name:SHIRNEK
Last Name:WATSON
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 1:109 YORKTOWN DR STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3673
Mailing Address - Country:US
Mailing Address - Phone:318-715-9608
Mailing Address - Fax:
Practice Address - Street 1:109 YORKTOWN DR STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3673
Practice Address - Country:US
Practice Address - Phone:318-715-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator