# KELLY ANN WITTENBROOK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1073868519
- **Gender:** F
- **Credential:** ANP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 0024172480 | VA | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | 306145 | NY | — |
| 363LA2200X | Adult Health Nurse Practitioner | APN.29631 | SC | — |
| 363LA2200X | Adult Health Nurse Practitioner | APRN.CNP.0037515 | OH | — |

## Other

- **Enumeration date:** 07/20/2012
- **Last updated:** 02/13/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01406284 | — | NY |