MEDICARE: JAMIE WITHERSPOON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider	300104890	IN

General Provider Information

NPI Number	:	1578446282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE WITHERSPOON

Provider Business Mailing Address
First Line	:	3322 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5912
Country	:	US
Telephone Number	:	260-438-8443
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5912
Country	:	US
Telephone Number	:	260-438-8443
Fax Number	:	260-438-8443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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Directions to “ JAMIE WITHERSPOON ” Practice Location

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