Provider Demographics
NPI:1558032227
Name:WATKINS, JADRIAN DB (PMHNP)
Entity Type:Individual
Prefix:
First Name:JADRIAN
Middle Name:DB
Last Name:WATKINS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2139
Mailing Address - Country:US
Mailing Address - Phone:330-322-2348
Mailing Address - Fax:
Practice Address - Street 1:196 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2139
Practice Address - Country:US
Practice Address - Phone:330-322-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.460025163WP0808X
OHAPRN.CNP.0030687363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health