Healthcare Provider Details

I. General information

NPI: 1013559848
Provider Name (Legal Business Name): WHITNEY ANN WHITAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY ANN HANKINS PA-C

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 FOUNTAIN CT STE 220
LEXINGTON KY
40509-2696
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-629-7265
  • Fax: 859-629-7266
Mailing address:
  • Phone:
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2553
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: