Individual
KELLIE DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
385 S ORANGE STREET, EL PASO, IL 71738
(309) 527-4900
(309) 527-3525
Mailing address
385 S ORANGE ST, EL PASO, IL 61738-1613
(309) 527-4900
(309) 527-3525
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003478
IL
Other
Enumeration date
07/10/2009
Last updated
09/15/2014
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