Healthcare Provider Details

I. General information

NPI: 1255405379
Provider Name (Legal Business Name): BRUCE E. WHITWELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23150 I 30
BRYANT AR
72022-1405
US

IV. Provider business mailing address

3515 RICHMOND RD
TEXARKANA TX
75503-0711
US

V. Phone/Fax

Practice location:
  • Phone: 501-888-9047
  • Fax: 501-213-0531
Mailing address:
  • Phone: 903-791-9355
  • Fax: 903-793-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-300
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: