Healthcare Provider Details

I. General information

NPI: 1164268157
Provider Name (Legal Business Name): JADE ALYSE-HAWLEY WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LAMBERT DR APT 2
HURRICANE WV
25526-1185
US

IV. Provider business mailing address

792 CHASE DR
HURRICANE WV
25526-7372
US

V. Phone/Fax

Practice location:
  • Phone: 304-741-5082
  • Fax:
Mailing address:
  • Phone: 304-741-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1062575
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number106275
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: