Provider Demographics
NPI:1427161975
Name:WATSON, ERIKA JOANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:JOANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:JOANNE
Other - Last Name:PENROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:STE 214
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-773-4123
Mailing Address - Fax:937-773-7717
Practice Address - Street 1:280 LOONEY RD
Practice Address - Street 2:STE 204
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4199
Practice Address - Country:US
Practice Address - Phone:937-773-4123
Practice Address - Fax:937-773-7717
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072646Medicaid
OH0072646Medicaid
OHH160660Medicare PIN