MEDICARE: MARY ELIZABETH WATSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA3372	KY

General Provider Information

NPI Number	:	1487219879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH WATSON PA

Provider Business Mailing Address
First Line	:	3084 LAKECREST CIR STE 100
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1972
Country	:	US
Telephone Number	:	859-639-1210
Fax Number	:	859-639-1211

Provider Business Practice Location Address
First Line	:	3084 LAKECREST CIR STE 100
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1972
Country	:	US
Telephone Number	:	859-639-1210
Fax Number	:	859-639-1211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	05/21/2026

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