MEDICARE: KERRI WHITMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator
3	251B00000X	Case Management Agency
4	251S00000X	Community/Behavioral Health Agency
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1942024716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI WHITMAN

Provider Business Mailing Address
First Line	:	6642 PHELAN BLVD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-5966
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6642 PHELAN BLVD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-5966
Country	:	US
Telephone Number	:	409-242-1559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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Directions to “ KERRI WHITMAN ” Practice Location

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