Healthcare Provider Details

I. General information

NPI: 1649196635
Provider Name (Legal Business Name): ISABELLA FAITH WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABELLA HAMMONS

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 S DIXIE BLVD
RADCLIFF KY
40160-1219
US

IV. Provider business mailing address

PO BOX 1434
PINE KNOT KY
42635-1434
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-0880
  • Fax:
Mailing address:
  • Phone: 606-310-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberI17376
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: