Healthcare Provider Details

I. General information

NPI: 1699084780
Provider Name (Legal Business Name): ALLEN JOHN WATSON C.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
COLUMBUS OH
43205-1381
US

IV. Provider business mailing address

4190 MUMFORD CT
UPPER ARLINGTON OH
43220-4435
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-3636
  • Fax:
Mailing address:
  • Phone: 614-457-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11593-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: