Provider Demographics
NPI:1346397189
Name:WATTS-BAKER, JULIE RENAE (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RENAE
Last Name:WATTS-BAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 BLAKENROD BLVD
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-6561
Mailing Address - Country:US
Mailing Address - Phone:502-264-3804
Mailing Address - Fax:
Practice Address - Street 1:167 BLAKENROD BLVD
Practice Address - Street 2:
Practice Address - City:COXS CREEK
Practice Address - State:KY
Practice Address - Zip Code:40013-6561
Practice Address - Country:US
Practice Address - Phone:502-264-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4912A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered