Healthcare Provider Details

I. General information

NPI: 1861463374
Provider Name (Legal Business Name): COMPREHENSIVE WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 AIRPORT ROAD
KINSTON NC
28504-8814
US

IV. Provider business mailing address

PO BOX 5485
KINSTON NC
28503-5485
US

V. Phone/Fax

Practice location:
  • Phone: 252-527-9928
  • Fax: 252-527-9929
Mailing address:
  • Phone: 252-527-9928
  • Fax: 252-527-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH D WHITLARK
Title or Position: OWNER
Credential: MD
Phone: 252-939-9300