Healthcare Provider Details

I. General information

NPI: 1124899646
Provider Name (Legal Business Name): KIMBERLY WATTS APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PROPRIETORS RD
WORTHINGTON OH
43085-3284
US

IV. Provider business mailing address

1035 PROPRIETORS RD
WORTHINGTON OH
43085-3284
US

V. Phone/Fax

Practice location:
  • Phone: 614-296-8193
  • Fax:
Mailing address:
  • Phone: 614-296-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0037478
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.521942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: