MEDICARE: DOUGLAS LEE WATSON PMHNP

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	1030062854	IN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71013479A	IN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	IN3604	OTHER	IN	MEDICARE
4	K258180	OTHER	KY	MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1770211658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS LEE WATSON PMHNP

Provider Business Mailing Address
First Line	:	2855 CHARLESTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2691
Country	:	US
Telephone Number	:	502-265-5866
Fax Number	:	765-308-5660

Provider Business Practice Location Address
First Line	:	2855 CHARLESTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2691
Country	:	US
Telephone Number	:	502-265-5866
Fax Number	:	765-308-5660

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

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	01/22/2025

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax: