Provider Demographics
NPI:1407582398
Name:DEWITT, KIERSTIN (ND)
Entity Type:Individual
Prefix:DR
First Name:KIERSTIN
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48441 BEAVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3373
Mailing Address - Country:US
Mailing Address - Phone:810-357-8238
Mailing Address - Fax:
Practice Address - Street 1:48441 BEAVER CREEK DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3373
Practice Address - Country:US
Practice Address - Phone:810-357-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134130175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath