Healthcare Provider Details

I. General information

NPI: 1003181611
Provider Name (Legal Business Name): MRS. ASHLEY BETH WATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S CHURCH ST
BERRYVILLE VA
22611-1369
US

IV. Provider business mailing address

136 LINDEN DR SUITE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-4811
  • Fax: 540-955-0976
Mailing address:
  • Phone: 540-678-3588
  • Fax: 540-678-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number203742
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024171488
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: