Individual provider Active NPI

Mercedes Danielle Witt, PA-C

  • Physician Assistant
  • Fort Campbell, KY
National Provider Identifier
1154965242
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4401 Issued in TN
Practice address
650 Joel Dr
Fort Campbell, KY 42223-8355
Phone
(270) 798-8400
NPI assigned
Oct 31, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4401 TN Primary

Addresses

Primary practice location

650 Joel Dr
Fort Campbell, KY 42223-8355

Mailing address

650 Joel Dr
Fort Campbell, KY 42223-8355
Phone (270) 798-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210601000417 TN Practitioner - Physician Assistant 2668871369 Reassigns benefits to 2 organizations
I20221116002578 KY Practitioner - Physician Assistant 2668871369

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, shared by 15 NPIs, 737 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

100 E Tennessee St
Collinwood, TN 38450
Phone (931) 724-9000

1609 Jones St
Springfield, TN 37172-3718
Phone (615) 433-8201

4696 Nashville Hwy
Chapel Hill, TN 37034-2110
Phone (931) 364-5321

980 Professional Park Dr
Clarksville, TN 37040-5251
Phone (931) 221-9967

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Upperline Healthcare, PC CurrentSince Oct 2, 2025 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Sep 17, 2025 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Sep 17, 2025 Accepting new patients
Upperline Healthcare, PC CurrentSince Oct 2, 2025 Accepting new patients

Locations

7348 E Brainerd Rd
Chattanooga, TN 37421
Phone (205) 822-8038

235 Highway 52 W
Portland, TN 37148
Phone (615) 802-1087

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1154965242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422238355",
            "telephone_number": "270-798-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422238355",
            "telephone_number": "270-798-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "MERCEDES",
        "middle_name": "DANIELLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Campbell, KY

Sources for this page

Verify at the official NPI Registry.