Healthcare Provider Details

I. General information

NPI: 1457298044
Provider Name (Legal Business Name): EMILY NICOLE WITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W POPLAR ST
ROGERS AR
72756-4245
US

IV. Provider business mailing address

1233 W POPLAR ST
ROGERS AR
72756-4245
US

V. Phone/Fax

Practice location:
  • Phone: 855-438-2280
  • Fax:
Mailing address:
  • Phone: 855-438-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1001480
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: