Koran Bianca Watson

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DN0006020 Issued in PA

Practice address

21 S 11TH St
Philadelphia, PA 19107-4223

Phone

(267) 209-3245

Fax

(267) 907-8591

NPI assigned

Jan 2, 2020

Last updated

Aug 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: koranwatson@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Koran Watson Haven of Health LLC

  • Registered Dietitian
  • Philadelphia, PA
  • NPI 1104401322
  Medicare reassignment Authorized official
• Indelible Health & Wellness LLC

  dba Texas Visiting Doctors

  • Family Medicine Physician
  • Grand Prairie, TX
  • NPI 1245569946
  NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Dietitian, Registered

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1174162572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074223",
            "telephone_number": "267-209-3245",
            "fax_number": "267-907-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074223",
            "telephone_number": "267-209-3245",
            "fax_number": "267-907-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "KORAN",
        "middle_name": "BIANCA",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-02",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006020",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN0006020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA NURSING BROAD",
            "identifier": "DN006020",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ernest A Watson Jr., D.C.
• Karma Watson
• Katie Marie Watson
• Kenneth Lee Watson
• Kimberley Monique Watson, MD
• Marcia G Watson, D.O.
• Mia Watson, PA-C
• Nashonne Watson, MA, LPC
• Quiana Natasha Watson
• Sandra Ann Watson

• Registered Dietitian in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.