Healthcare Provider Details

I. General information

NPI: 1942575667
Provider Name (Legal Business Name): STEPHEN DANIEL WHIPKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17210 LANCASTER HWY SUITE 401
CHARLOTTE NC
28277-2024
US

IV. Provider business mailing address

17210 LANCASTER HWY SUITE 401
CHARLOTTE NC
28277-2024
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-2930
  • Fax: 704-752-3808
Mailing address:
  • Phone: 704-332-2930
  • Fax: 704-752-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number817
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number400
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: