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NPI Code Detail

MEDICARE: RYAN TRENT WATTS CRNA

MEDICARE: RYAN TRENT WATTS CRNA
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
1171M00000XCase Manager/Care Coordinator
2367500000XCertified Registered Nurse Anesthetist108186WV

General Provider Information

NPI Number : 1790441525
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN TRENT WATTS CRNA
Provider Business Mailing Address
First Line : 100 PEYTON WAY STE 200
Second Line :
City : CHARLESTON
State : WV
Zip : 25309-8545
Country : US
Telephone Number : 304-720-8816
Fax Number : 904-494-6467
Provider Business Practice Location Address
First Line : 1400 HOSPITAL DR
Second Line :
City : HURRICANE
State : WV
Zip : 25526-9202
Country : US
Telephone Number : 304-720-8816
Fax Number : 904-494-6467
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2021
Last Update Date : 06/02/2026

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Directions to “ RYAN TRENT WATTS CRNA” Practice Location

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