Provider Demographics
NPI:1780677807
Name:DEWITT, DAVID D (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:D
Last Name:DEWITT
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6332 FUTURITY DR
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-8912
Mailing Address - Country:US
Mailing Address - Phone:405-229-5885
Mailing Address - Fax:
Practice Address - Street 1:6332 FUTURITY DR
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-8912
Practice Address - Country:US
Practice Address - Phone:405-229-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0038273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily