MEDICARE: KELLY WATTERS DNP, ANP-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	363LF0000X	Family Nurse Practitioner	APRN002043	NV
2	363LA2200X	Adult Health Nurse Practitioner	APRN002043	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1942214408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY WATTERS DNP, ANP-C

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	615-314-8069
Fax Number	:	615-692-0547

Provider Business Practice Location Address
First Line	:	1501 W SUNSET RD
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6636
Country	:	US
Telephone Number	:	725-269-7001
Fax Number	:	725-269-7003

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	06/27/2023

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