Provider Demographics
NPI:1922448919
Name:WATTS, PATRICIA ANN (PNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:WATTS
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 N DOG TROT LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46160-8957
Mailing Address - Country:US
Mailing Address - Phone:812-703-0776
Mailing Address - Fax:812-855-6986
Practice Address - Street 1:5040 STATE ROAD 67 NORTH
Practice Address - Street 2:BRADFORD WOODS HEALTH CENTER
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151
Practice Address - Country:US
Practice Address - Phone:812-703-0776
Practice Address - Fax:765-349-1086
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002669A261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71002669AOtherLICENSE NUMBER
INMW1792616OtherDEA NUMBER