Healthcare Provider Details

I. General information

NPI: 1073526299
Provider Name (Legal Business Name): JACKI SUE WITT MSN, RNC, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRUMAN MEDICAL CENTER 2301 HOLMES ROAD
KANSAS CITY MO
64108
US

IV. Provider business mailing address

3801 NE 77TH ST
GLADSTONE MO
64119-1267
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-1700
  • Fax: 816-235-1701
Mailing address:
  • Phone: 816-235-1700
  • Fax: 816-235-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number075834
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: