Provider Demographics
NPI:1700969730
Name:WATTS, JESSE T (PA-C)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:T
Last Name:WATTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:153 W 151ST ST
Mailing Address - Street 2:#100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5348
Mailing Address - Country:US
Mailing Address - Phone:913-764-1125
Mailing Address - Fax:913-764-1186
Practice Address - Street 1:153 W 151ST ST
Practice Address - Street 2:#100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5348
Practice Address - Country:US
Practice Address - Phone:913-764-1125
Practice Address - Fax:913-764-1186
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1501053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSM82E295Medicare PIN
Q61204Medicare UPIN