Provider Demographics
NPI:1174547269
Name:WATTS, KRISTI (APRN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:197 ANTLER DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-8223
Mailing Address - Country:US
Mailing Address - Phone:606-233-4575
Mailing Address - Fax:
Practice Address - Street 1:210 BLACK GOLD BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2620
Practice Address - Country:US
Practice Address - Phone:606-436-0711
Practice Address - Fax:606-436-0848
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004377363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013018Medicaid
KYQ31057Medicare UPIN
KY78013018Medicaid
KY52634Medicare ID - Type UnspecifiedJUNE BUCHANAN CLINIC MC
KY1261934Medicare PIN