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General NPI Number Information
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NPI Number | 1154965242
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Entity Type | Individual
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Provider Name | MERCEDES DANIELLE WITT PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1763 MADISON ST
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City | CLARKSVILLE
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State | TN
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Zip | 37043-4990
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Country | US
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Telephone | 931-278-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 JONES ST
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City | SPRINGFIELD
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State | TN
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Zip | 37172-3718
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Country | US
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Telephone | 615-433-8201
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Fax | 615-433-8202
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4401
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License Number State | TN
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