Provider Demographics
NPI:1689116097
Name:WATSON, BRAD ALLEN (NP)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:ALLEN
Last Name:WATSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-2070
Mailing Address - Country:US
Mailing Address - Phone:865-218-2100
Mailing Address - Fax:865-218-2101
Practice Address - Street 1:3959 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-4417
Practice Address - Country:US
Practice Address - Phone:423-442-2121
Practice Address - Fax:865-246-2106
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily