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General NPI Number Information
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NPI Number | 1073868519
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Entity Type | Individual
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Provider Name | KELLY ANN WITTENBROOK ANP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 3000 COLISEUM DR FL 2
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City | HAMPTON
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State | VA
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Zip | 23666-5963
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Country | US
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Telephone | 757-736-1347
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Fax |
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Provider Business Mailing Address
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Address Line | 3155 GUINEA CIR
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City | HAYES
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State | VA
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Zip | 23072-4220
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Country | US
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Telephone | 716-397-9492
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Fax | 716-338-1575
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN.CNP.0037515
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 306145
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN.29631
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024172480
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License Number State | VA
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