Healthcare Provider Details

I. General information

NPI: 1154788479
Provider Name (Legal Business Name): WHITLEY VIRGIL P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 COLCORD DR STE A
OKLAHOMA CITY OK
73102-2500
US

IV. Provider business mailing address

424 COLCORD DR STE A
OKLAHOMA CITY OK
73102-2500
US

V. Phone/Fax

Practice location:
  • Phone: 405-276-2030
  • Fax: 405-422-9760
Mailing address:
  • Phone: 405-276-2030
  • Fax: 405-422-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2577
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: