Healthcare Provider Details

I. General information

NPI: 1770414773
Provider Name (Legal Business Name): MICAYLA EVE WITHERITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 PARKDALE PL STE 212
INDIANAPOLIS IN
46254-6600
US

IV. Provider business mailing address

1047 S JEFFERSON ST
BROWNSBURG IN
46112-1888
US

V. Phone/Fax

Practice location:
  • Phone: 317-219-2700
  • Fax:
Mailing address:
  • Phone: 614-425-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71018178A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: