MEDICARE: KARYN R WATTERS M.D.

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	207Q00000X	Family Medicine Physician	28073	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00181549	OTHER	KY	RAILROAD MEDICARE

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
2	041703	OTHER	KY	SIHO - ICC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	509829	OTHER	KY	ANTHEM - ICC

General Provider Information

NPI Number	:	1992760458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARYN R WATTERS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	12903 SHELBYVILLE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1538
Country	:	US
Telephone Number	:	502-244-5827
Fax Number	:	502-244-5829

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	09/21/2022

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Directions to “ KARYN R WATTERS M.D.” Practice Location

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