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General NPI Number Information
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NPI Number | 1124019310
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Entity Type | Individual
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Provider Name | KELLY A WATTS FNP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3903 S 7TH ST SUITE 2D
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City | TERRE HAUTE
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State | IN
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Zip | 47802-5710
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Country | US
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Telephone | 812-232-3191
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Fax | 812-234-7839
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Provider Business Mailing Address
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Address Line | 2723 S 7TH ST SUITE A
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City | TERRE HAUTE
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State | IN
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Zip | 47802-3584
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Country | US
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Telephone | 812-238-1730
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Fax | 812-242-1565
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71001710A
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License Number State | IN
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