Provider Demographics
NPI:1821428699
Name:WITTY, KEVIN (RN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:WITTY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-3503
Mailing Address - Country:US
Mailing Address - Phone:434-676-1375
Mailing Address - Fax:434-676-1391
Practice Address - Street 1:231 HICKORY RD
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-3503
Practice Address - Country:US
Practice Address - Phone:434-676-1375
Practice Address - Fax:434-676-1391
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1993451570163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent