Provider Demographics
NPI:1700945185
Name:DEWITT, KAREN A (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:DEWITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37087
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3087
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:303 TAKOMA AVE
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4629
Practice Address - Country:US
Practice Address - Phone:423-636-0491
Practice Address - Fax:423-636-2425
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPRN0000005459163WP0807X
TN42770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01417880OtherMEDICARE RR
TN1512779Medicaid
TNP01417880OtherMEDICARE RR
TN10350I3449Medicare PIN