Ili Wathen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0004349 Issued in MD

Practice address

3500 Old Washington Rd Ste 201
Waldorf, MD 20602-3238

Phone

(301) 396-2003

Fax

(240) 222-3134

NPI assigned

Oct 18, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1063722577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11565 FARM DR",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465417",
            "telephone_number": "301-752-3667",
            "fax_number": "240-222-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 OLD WASHINGTON RD STE 201",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023238",
            "telephone_number": "301-396-2003",
            "fax_number": "240-222-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATHEN",
        "first_name": "ILI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-18",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0004349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Washington
• Zackery Washington
• Washington'S Purplel Hearts
• Waterfront Medical, LLC
• George H Wathen, MD PA
• Christine Watkins
• Nicole Renee Watkins
• Casey Watson
• Roche Watson
• Kamilah Way, LICSW, LCSW-C

• Physician Assistant in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.