Provider Demographics
NPI:1417366907
Name:WITTY, ADRIENNE NYCOLE (BA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:NYCOLE
Last Name:WITTY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3944
Mailing Address - Country:US
Mailing Address - Phone:918-533-5388
Mailing Address - Fax:
Practice Address - Street 1:1800 W 30TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1520
Practice Address - Country:US
Practice Address - Phone:417-347-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker