Healthcare Provider Details

I. General information

NPI: 1851484778
Provider Name (Legal Business Name): BARTON, WATTS, & PERRY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BISHOP ST
CORBIN KY
40701-1702
US

IV. Provider business mailing address

121 BISHOP ST
CORBIN KY
40701-1702
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2124
  • Fax: 606-528-8272
Mailing address:
  • Phone: 606-528-2124
  • Fax: 606-528-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. JOHN MICHAEL WATTS
Title or Position: VICE-PRESIDENT
Credential: M.D.
Phone: 606-528-2124