Provider Demographics
NPI:1518425149
Name:WITTY, DAVID WAYNE (APRN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:WITTY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SUBURBAN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2335
Mailing Address - Country:US
Mailing Address - Phone:512-415-5942
Mailing Address - Fax:
Practice Address - Street 1:5200 SUBURBAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2335
Practice Address - Country:US
Practice Address - Phone:512-415-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-02
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140689363LF0000X
COC-APN.0992697-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily