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General NPI Number Information
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NPI Number | 1922448919
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Entity Type | Individual
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Provider Name | PATRICIA ANN WATTS PNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5040 STATE ROAD 67 NORTH BRADFORD WOODS HEALTH CENTER
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City | MARTINSVILLE
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State | IN
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Zip | 46151
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Country | US
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Telephone | 812-703-0776
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Fax | 765-349-1086
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Provider Business Mailing Address
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Address Line | 8035 N DOG TROT LN
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City | MORGANTOWN
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State | IN
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Zip | 46160-8957
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Country | US
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Telephone | 812-703-0776
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Fax | 812-855-6986
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 71002669A
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License Number State | IN
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