Healthcare Provider Details

I. General information

NPI: 1659608735
Provider Name (Legal Business Name): ANGELA R WHATLEY RN CERT. LABOR DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W TYLER AVE
WEST MEMPHIS AR
72301-4223
US

IV. Provider business mailing address

12718 STATE HIGHWAY 118
TYRONZA AR
72386-8984
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-5527
  • Fax:
Mailing address:
  • Phone: 870-636-5231
  • Fax: 870-735-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberR41550
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: