Provider Demographics
NPI:1942214408
Name:WATTERS, KELLY (DNP, ANP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WATTERS
Suffix:
Gender:F
Credentials:DNP, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-8069
Mailing Address - Fax:615-692-0547
Practice Address - Street 1:1501 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6636
Practice Address - Country:US
Practice Address - Phone:725-269-7001
Practice Address - Fax:725-269-7003
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002043363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1942214408Medicaid
NV71683OtherRN LICENSE NUMBER
COAPN 5009OtherREGISTRY NUMBER FOR APN