KELLY ANN WITTENBROOK (NPI# 1073868519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073868519 |
| Entity Type | Individual |
| Full Name | KELLY ANN WITTENBROOK |
| Credential | ANP |
| Practice Address |
20 W Fairmount Ave Lakewood NY 14750 |
| Mailing Address |
5716 Route 380 Sinclairville NY 14782-9657 |
| Practice Telephone | 7163380033 |
| Practice Fax Number | 7163381575 |
| Mailing Telephone | 7164447551 |
| Mailing Fax Number | 7163381575 |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2018-05-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
306145 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01406284 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 715 Falconer St, Jamestown, NY 147011935 | 7166658137 |
| Street Address |
20 W FAIRMOUNT AVE |
| City | LAKEWOOD |
| State | NY |
| Zip Code | 14750 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164466710 | Mary H Rappole | Nurse Practitioner | 20 W Fairmount Ave, Lakewood, NY 14750-1702 | 2006-06-15 |
| 1356745004 | Benjamin Edward Probst | Social Worker | 20 W Fairmount Ave, Lakewood, NY 14750-1702 | 2014-10-09 |
| 1477998029 | Debra Arlene Przepiora | Licensed Practical Nurse | 20 W Fairmount Ave, Lakewood, NY 14750 | 2013-05-08 |
| 1497190607 | Bethanie Anne Milner | Registered Nurse | 20 W Fairmount Ave, Lakewood, NY 14750-1702 | 2013-05-01 |
| 1598883506 | Thomas Alan Putnam | Family Medicine | 20 W Fairmount Ave, Lakewood, NY 14750-1702 | 2007-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699163147 | Craig Richards | Physician Assistant | 390 E Fairmount Ave, Lakewood, NY 14750 | 2015-01-07 |
| 1982849659 | Syed Ali Raza Shamsi | Psychiatry & Neurology | 305 E. Fairmont Avenue, Unit 7, Lakewood, NY 14750 | 2008-12-10 |
| 1942417977 | Stephen C Barresi | Physician Assistant | Chd Meridian Healthcare, Jep, 4720 Bakerst, Ext., Lakewood, NY 14750 | 2007-05-17 |
| 1295947117 | Harold Ronald Carlson | Dentist | 2 East Main Street, Suite 115, Falconer, NY 14750 | 2007-05-04 |
| 1194865907 | David William Todd | Dentist | 120 Southwestern Dr, Lakewood, NY 14750 | 2007-02-08 |
| 1730271248 | Lee Ryan Anderson | Dentist | 909 Hunt Road, Lakewood, NY 14750 | 2006-09-29 |
| 1962416362 | Us Vision Optical Inc | Eyewear Supplier (Equipment, not the service) | Rt 394 Mall Blvd, Lakewood, NY 14750 | 2006-07-28 |
| 1518925437 | Israr A Abbasi | Psychiatry & Neurology | 305 E Fairmount Ave, Lakewood, NY 14750 | 2006-05-02 |
| 1992771190 | Robert Gibbon Jr. | Psychiatry & Neurology | 92 W. Summit St., Lakewood, NY 14750 | 2006-02-27 |
| 1295213684 | Allison Claire Munella | Physician Assistant | 305 E Fairmount Ave, Lakewood, NY 14750 | 2018-07-30 |
| Find all providers in zip 14750 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235522483 | Jennifer Miranda Vicente | Nurse Practitioner | 3300 E South St Ste 205, Lakewood, CA 90805-4587 | 2015-03-12 |
| 1477997666 | Melanie Rose Vernacchia | Nurse Practitioner | 600 River Ave Fl 3, Lakewood, NJ 08701-5237 | 2013-04-18 |
| 1245576834 | Regina B Glisson | Nurse Practitioner | 101 Second St, Lakewood, NJ 08701 | 2012-12-31 |
| 1982818803 | Linda J Leblanc | Nurse Practitioner | 10814 Deepwood Dr Sw, Lakewood, WA 98498 | 2007-05-09 |
| 1982704441 | Nancy Irene Brooker | Nurse Practitioner | 11700 W 2nd Pl Ste 450, Lakewood, CO 80228-1719 | 2006-09-25 |
| 1447712781 | Olanrewaju Famakinwa | Nurse Practitioner | 685 River Ave, Lakewood, NJ 08701-5288 | 2019-04-04 |
| 1285144758 | Ann Pereira | Nurse Practitioner | 1526 Cole Blvd Ste 300, Lakewood, CO 80401-3410 | 2017-10-10 |
| 1235648890 | Natalia C Spencer | Nurse Practitioner | 1526 Cole Blvd Ste 300, Lakewood, CO 80401-3410 | 2017-09-27 |
| 1679096630 | Amber Brooke Hyland | Nurse Practitioner | 13900 Detroit Ave, Lakewood, OH 44107-4624 | 2017-07-21 |
| 1518496991 | Frank Ross Arnp LLC | Nurse Practitioner | 4901 108th St Sw, Lakewood, WA 98499-3724 | 2017-06-08 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.