MEDICARE: KAYLEA BROOKE WATSON PA-C

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	5223	TN

General Provider Information

NPI Number	:	1912616426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEA BROOKE WATSON PA-C

Provider Business Mailing Address
First Line	:	401 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4011
Country	:	US
Telephone Number	:	423-328-3386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 E CENTER ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2444
Country	:	US
Telephone Number	:	423-245-2078
Fax Number	:

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

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	05/07/2025

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