Healthcare Provider Details

I. General information

NPI: 1760091003
Provider Name (Legal Business Name): RACHEL WHITLEY AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALTER WARD BLVD STE 300
ABINGDON MD
21009-1286
US

IV. Provider business mailing address

100 WALTER WARD BLVD
ABINGDON MD
21009-1284
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-8971
  • Fax: 877-595-7180
Mailing address:
  • Phone: 410-777-8971
  • Fax: 877-595-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG06200254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: