Active NPI
Kelly Jo Wittway
- Community Health Worker
- Alliance, OH
National Provider Identifier
1093073934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 401189970111
- Practice address
- 12049 Bandy Rd
Alliance, OH 44601-9212 - Phone
- (330) 584-2150
- NPI assigned
- Apr 29, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 401189970111 | OH | Primary |
Addresses
Primary practice location
12049 Bandy Rd
Alliance, OH 44601-9212
Mailing address
12049 Bandy Rd
Alliance, OH 44601-9212
Phone (330) 584-2150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 401189970111 | OH | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335657600000",
"number": "1093073934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12049 BANDY RD",
"city": "ALLIANCE",
"state": "OH",
"postal_code": "446019212",
"telephone_number": "330-584-2150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12049 BANDY RD",
"city": "ALLIANCE",
"state": "OH",
"postal_code": "446019212",
"telephone_number": "330-584-2150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTWAY",
"first_name": "KELLY",
"middle_name": "JO",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-29",
"last_updated": "2012-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OH",
"license": "401189970111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alliance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.