Healthcare Provider Details

I. General information

NPI: 1285272849
Provider Name (Legal Business Name): GEOFFREY T WATSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ROUTE 664 N
LOGAN OH
43138-8541
US

IV. Provider business mailing address

216 CHATEAUGAY DR
PATASKALA OH
43062-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-380-8000
  • Fax:
Mailing address:
  • Phone: 740-501-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.026230
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01200916
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026230
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: