MEDICARE: BRANDI L. WATTS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4049694	KY
2	163W00000X	Registered Nurse	68850	WV
3	363LF0000X	Family Nurse Practitioner	4049694	KY
4	363LA2100X	Acute Care Nurse Practitioner	113671	WV

General Provider Information

NPI Number	:	1578206561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI L. WATTS APRN

Provider Business Mailing Address
First Line	:	100 HOPE FARM LN
Second Line	:
City	:	PRICHARD
State	:	WV
Zip	:	25555-8248
Country	:	US
Telephone Number	:	304-417-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 1ST AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1241
Country	:	US
Telephone Number	:	304-526-1232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	01/06/2026

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