Provider Demographics
NPI:1497023477
Name:WATSON, BOBBI JO (NP-C)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 TYLERSVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2533
Mailing Address - Country:US
Mailing Address - Phone:513-622-9595
Mailing Address - Fax:
Practice Address - Street 1:5633 TYLERSVILLE RD STE B5633
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2533
Practice Address - Country:US
Practice Address - Phone:513-622-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP12798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069531Medicaid
OH0069531Medicaid