Healthcare Provider Details

I. General information

NPI: 1427161975
Provider Name (Legal Business Name): ERIKA JOANNE WATSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA JOANNE PENROD PA-C

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 LOONEY RD STE 204
PIQUA OH
45356-4199
US

IV. Provider business mailing address

3130 N COUNTY ROAD 25A STE 214
TROY OH
45373-1337
US

V. Phone/Fax

Practice location:
  • Phone: 937-773-4123
  • Fax: 937-773-7717
Mailing address:
  • Phone: 937-773-4123
  • Fax: 937-773-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: