Healthcare Provider Details

I. General information

NPI: 1366206989
Provider Name (Legal Business Name): MONIQUE WHITELY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 300
LITTLE RIVER SC
29566-8165
US

IV. Provider business mailing address

3980 HIGHWAY 9 E STE 300
LITTLE RIVER SC
29566-8165
US

V. Phone/Fax

Practice location:
  • Phone: 843-646-8040
  • Fax:
Mailing address:
  • Phone: 843-646-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: