Provider Demographics
NPI:1033977897
Name:WATTS, KEYION AARON SR
Entity Type:Individual
Prefix:
First Name:KEYION
Middle Name:AARON
Last Name:WATTS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HELMKAMPF DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6540
Mailing Address - Country:US
Mailing Address - Phone:314-313-6431
Mailing Address - Fax:
Practice Address - Street 1:1155 N HIGHWAY 67 ST STE A
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4701
Practice Address - Country:US
Practice Address - Phone:314-313-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health