Provider Demographics
NPI:1740955418
Name:WITTER, SARAH KATHERINE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KATHERINE
Last Name:WITTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S BEAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:TX
Mailing Address - Zip Code:76035-5858
Mailing Address - Country:US
Mailing Address - Phone:573-673-5106
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 512
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1053
Practice Address - Country:US
Practice Address - Phone:888-684-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty