Healthcare Provider Details

I. General information

NPI: 1811521487
Provider Name (Legal Business Name): ANDREW WILLIAM DEWITT DNP, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2020
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11605 E 23RD ST S
INDEPENDENCE MO
64050-4201
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 816-579-6891
  • Fax:
Mailing address:
  • Phone: 888-987-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79312-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: