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Individual

KELLY ANN WITTENBROOK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ANP

Contact information

Practice address
3000 COLISEUM DR FL 2, HAMPTON, VA 23666-5963
(757) 736-1347
Mailing address
3155 GUINEA CIR, HAYES, VA 23072-4220
(716) 397-9492
(716) 338-1575

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172480
VA
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

Other identifiers
Code
Description
Identifier
Issuer
State
05
01406284
NY
Enumeration date
07/20/2012
Last updated
02/13/2025
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