Provider Demographics
NPI:1457115933
Name:WATTS, KELLY MICHELLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELLE
Last Name:WATTS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARLISLE PL
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3684
Mailing Address - Country:US
Mailing Address - Phone:864-276-1948
Mailing Address - Fax:
Practice Address - Street 1:600 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5704
Practice Address - Country:US
Practice Address - Phone:864-512-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily