Provider Demographics
NPI:1962270017
Name:HEWITT, JAMES MITCHELL (LAT, ATC, CES)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MITCHELL
Last Name:HEWITT
Suffix:
Gender:M
Credentials:LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 N PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3021
Mailing Address - Country:US
Mailing Address - Phone:316-347-5661
Mailing Address - Fax:
Practice Address - Street 1:335 E SWENSSON AVE
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-1817
Practice Address - Country:US
Practice Address - Phone:316-347-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-01404207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine