Healthcare Provider Details

I. General information

NPI: 1427991975
Provider Name (Legal Business Name): JEFFREY WITT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15795 CANDLE CREEK DR
MONUMENT CO
80132-6012
US

IV. Provider business mailing address

15795 CANDLE CREEK DR
MONUMENT CO
80132-6012
US

V. Phone/Fax

Practice location:
  • Phone: 315-573-3189
  • Fax:
Mailing address:
  • Phone: 315-573-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1002325-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberMSRN.0000297
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.1002325-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: