Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 075834 | MO |
NPI | 1073526299 |
---|---|
Provider Name | Ms. Jacki Sue Witt |
First Address | Gladstone, MO 64119-1267 |
Second Address | Kansas City, MO 64108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 09/07/2007 |