Healthcare Provider Details

I. General information

NPI: 1700945185
Provider Name (Legal Business Name): KAREN A. DEWITT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 TAKOMA AVE
GREENEVILLE TN
37743-4629
US

IV. Provider business mailing address

PO BOX 37087
BALTIMORE MD
21297-3087
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-0491
  • Fax: 423-636-2425
Mailing address:
  • Phone: 828-687-5616
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberAPRN0000005459
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42770
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: