Provider Demographics
NPI:1417371238
Name:WITTY, JAIME ELLIS
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ELLIS
Last Name:WITTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 S. PECOS
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-739-8323
Mailing Address - Fax:
Practice Address - Street 1:9029 S PECOS RD
Practice Address - Street 2:SUITE 2800
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7197
Practice Address - Country:US
Practice Address - Phone:702-739-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1534363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant