Provider Demographics
NPI:1023381209
Name:WATTS, JOANNA HARDIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:HARDIE
Last Name:WATTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 WASHINGTON ST SW
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-1067
Mailing Address - Country:US
Mailing Address - Phone:540-231-6444
Mailing Address - Fax:540-231-9383
Practice Address - Street 1:895 WASHINGTON ST SW
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-1067
Practice Address - Country:US
Practice Address - Phone:540-231-6444
Practice Address - Fax:540-231-6900
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110003794OtherVA LICENSE