MEDICARE: ASHLEY WITTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	905466	MS

General Provider Information

NPI Number	:	1497444285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY WITTER

Provider Business Mailing Address
First Line	:	6113 C BYRD RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8240
Country	:	US
Telephone Number	:	228-327-6922
Fax Number	:

Provider Business Practice Location Address
First Line	:	6113 C BYRD RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8240
Country	:	US
Telephone Number	:	228-327-6922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	05/05/2023

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