Healthcare Provider Details

I. General information

NPI: 1972539302
Provider Name (Legal Business Name): AUTUMN BETH WHITLOCK-MORALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN BETH WHITLOCK-MORALES MD

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E GENERAL CAVAZOS BLVD STE 201
KINGSVILLE TX
78363-7123
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 361-595-2223
  • Fax: 361-595-9687
Mailing address:
  • Phone: 903-614-5372
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22119
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39466
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39466
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR9558
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: