Healthcare Provider Details

I. General information

NPI: 1477165363
Provider Name (Legal Business Name): KACEY WHISLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 FOREST HILL DR
HIGH POINT NC
27262-2818
US

IV. Provider business mailing address

1134 FOREST HILL DR
HIGH POINT NC
27262-2818
US

V. Phone/Fax

Practice location:
  • Phone: 210-445-4341
  • Fax:
Mailing address:
  • Phone: 210-445-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number177586
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: