Provider Demographics
NPI:1710432190
Name:WATTS, KEITH (PMHNP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:WATTS
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 1:708 WILL HALSEY WAY STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2566
Mailing Address - Country:US
Mailing Address - Phone:256-325-1349
Mailing Address - Fax:256-325-1354
Practice Address - Street 1:708 WILL HALSEY WAY
Practice Address - Street 2:STE C
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2565
Practice Address - Country:US
Practice Address - Phone:256-325-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134846363LP0808X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)