Individual provider Active NPI

Lindsey Brooke Witham, APRN

  • Family Nurse Practitioner
  • West Haven, CT
National Provider Identifier
1972140796
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2019071921 Issued in CT
Practice address
950 Campbell Ave
West Haven, CT 06516-2700
Phone
(203) 500-2129
NPI assigned
Dec 1, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2019071921 CT Primary

Addresses

Primary practice location

950 Campbell Ave
West Haven, CT 06516-2700

Mailing address

950 Campbell Ave
West Haven, CT 06516-2700
Phone (203) 500-2129

Other names 1

  • Lindsey Brooke Witham Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240807004260 CT Order and Referring Only - Nurse Practitioner 1254752918

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2019071921CTMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1575158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1972140796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065162700",
            "telephone_number": "203-500-2129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 CAMPBELL AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065162700",
            "telephone_number": "203-500-2129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITHAM",
        "first_name": "LINDSEY",
        "middle_name": "BROOKE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-01",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "2019071921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDSEY",
            "last_name": "WITHAM",
            "middle_name": "BROOKE",
            "credential": "COFFMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Haven, CT

Sources for this page

Verify at the official NPI Registry.