Provider Demographics
NPI:1851369904
Name:WATSON-GRAY, KATHIE L (MD)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:L
Last Name:WATSON-GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12955 STATE ROUTE 207
Mailing Address - Street 2:
Mailing Address - City:ARGILLITE
Mailing Address - State:KY
Mailing Address - Zip Code:41121-8743
Mailing Address - Country:US
Mailing Address - Phone:888-756-4224
Mailing Address - Fax:888-258-5785
Practice Address - Street 1:1610 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1372
Practice Address - Country:US
Practice Address - Phone:888-756-4224
Practice Address - Fax:888-258-5785
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091150Medicaid
OHWA0866811Medicare PIN
OH2091150Medicaid
WI361849Medicare PIN