Healthcare Provider Details

I. General information

NPI: 1083668461
Provider Name (Legal Business Name): JOY M WATSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY M HENDRICKS PA

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S GREENLEAF ST STE J
GURNEE IL
60031-3380
US

IV. Provider business mailing address

5201 WILLOW SPRINGS RD STE 430
LA GRANGE HIGHLANDS IL
60525-6538
US

V. Phone/Fax

Practice location:
  • Phone: 847-662-8201
  • Fax:
Mailing address:
  • Phone: 708-482-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001638
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: