Provider Demographics
NPI:1700304508
Name:WITT, KARIN C (FNP)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:C
Last Name:WITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11125 DUNN RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6188
Mailing Address - Country:US
Mailing Address - Phone:314-839-5125
Mailing Address - Fax:314-829-5351
Practice Address - Street 1:11125 DUNN RD STE 204
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6188
Practice Address - Country:US
Practice Address - Phone:314-839-5125
Practice Address - Fax:314-829-5351
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0414370057363LF0000X
MO2009010907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily