Healthcare Provider Details

I. General information

NPI: 1487578175
Provider Name (Legal Business Name): RUSSIA WHITTINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 FLORIDA BLVD STE C
BATON ROUGE LA
70806-4556
US

IV. Provider business mailing address

1205 NORTH ST APT 232
BATON ROUGE LA
70802-4549
US

V. Phone/Fax

Practice location:
  • Phone: 225-960-2474
  • Fax:
Mailing address:
  • Phone: 504-909-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number012168067
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: