Active NPI
Mary Kay Witte
- Audiologist
- Pueblo, CO
National Provider Identifier
1497966154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 7169
- Practice address
- 1471 29TH LN
Pueblo, CO 81006-9649 - Phone
- (719) 948-4609
- NPI assigned
- May 24, 2007
- 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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 7169 | CO | Primary |
Addresses
Primary practice location
1471 29TH LN
Pueblo, CO 81006-9649
Mailing address
1471 29TH LN
Pueblo, CO 81006-9649
Phone (719) 948-4609
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13783840 | Medicaid | CO |
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 |
|---|---|---|---|
| 7169 | CO | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1497966154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1471 29TH LN",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810069649",
"telephone_number": "719-948-4609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1471 29TH LN",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810069649",
"telephone_number": "719-948-4609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTE",
"first_name": "MARY",
"middle_name": "KAY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "CO",
"license": "7169",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13783840",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.