Provider Demographics
NPI:1407674245
Name:PREWITT, MISTY ANN
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:PREWITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4123
Mailing Address - Country:US
Mailing Address - Phone:423-239-5361
Mailing Address - Fax:800-524-8107
Practice Address - Street 1:516 W OAKLAND AVE STE 106
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1677
Practice Address - Country:US
Practice Address - Phone:423-328-1244
Practice Address - Fax:423-282-8397
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1066237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist