Healthcare Provider Details

I. General information

NPI: 1528828100
Provider Name (Legal Business Name): JODI WITMER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 KIETZKE LN BLDG L
RENO NV
89502-5033
US

IV. Provider business mailing address

4643 15TH ST N
ARLINGTON VA
22207-2144
US

V. Phone/Fax

Practice location:
  • Phone: 775-636-7767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number889653
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0102095-C-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024189812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: