Individual
SHANE MARK WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP-BC
Contact information
Practice address
801 BARRET AVE STE 110, LOUISVILLE, KY 40204-1732
(502) 792-0275
Mailing address
130 LAKELYNN AVE, SHELBYVILLE, KY 40065-7403
(502) 689-9994
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3017240
KY
Other
Enumeration date
01/13/2022
Last updated
10/30/2025
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