Provider Demographics
NPI:1427267442
Name:WATTS, RUTHIE J (RN)
Entity type:Individual
Prefix:
First Name:RUTHIE
Middle Name:J
Last Name:WATTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 59 BOX 1100
Mailing Address - Street 2:
Mailing Address - City:CABINS
Mailing Address - State:WV
Mailing Address - Zip Code:26855-9515
Mailing Address - Country:US
Mailing Address - Phone:304-257-1366
Mailing Address - Fax:
Practice Address - Street 1:111 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1713
Practice Address - Country:US
Practice Address - Phone:304-257-1666
Practice Address - Fax:304-257-9145
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49442163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030591000Medicaid
WV0030591001Medicaid