Provider Demographics
NPI:1215361191
Name:WATTS, EDWARD KEYLON (BA, MSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KEYLON
Last Name:WATTS
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Gender:M
Credentials:BA, MSW
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Other - First Name:
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Mailing Address - Street 1:3209 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7294
Mailing Address - Country:US
Mailing Address - Phone:702-510-7126
Mailing Address - Fax:702-478-8500
Practice Address - Street 1:2560 MONTESSOURI ST STE 207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3064
Practice Address - Country:US
Practice Address - Phone:702-478-5400
Practice Address - Fax:702-478-8500
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner