Healthcare Provider Details

I. General information

NPI: 1316317704
Provider Name (Legal Business Name): BRENT WHITLEY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 N 7TH ST STE 101
PHOENIX AZ
85014-1850
US

IV. Provider business mailing address

1801 E CAMELBACK ROAD SUITE 102, #1008
PHOENIX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-0914
  • Fax: 623-321-6050
Mailing address:
  • Phone: 623-233-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8187
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: