Individual
KENNETH WAYNE DEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
417759 EAST 1116 RD, CHECOTAH, OK 74426
(405) 493-5654
Mailing address
417759 EAST 1116 RD, CHECOTAH, OK 74426
(405) 493-5654
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/09/2024
Last updated
02/09/2024
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