Provider Demographics
NPI:1891062121
Name:WITSIEPE, KARA (PA-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:WITSIEPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2327
Mailing Address - Country:US
Mailing Address - Phone:251-344-7044
Mailing Address - Fax:251-344-4045
Practice Address - Street 1:5220 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2327
Practice Address - Country:US
Practice Address - Phone:251-344-7044
Practice Address - Fax:251-344-4045
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant