Healthcare Provider Details

I. General information

NPI: 1386119857
Provider Name (Legal Business Name): KRISTA RAYLYNN WHITAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 CLARKSVILLE ST STE 100
PARIS TX
75460-6089
US

IV. Provider business mailing address

1128 CLARKSVILLE ST STE 100
PARIS TX
75460-6089
US

V. Phone/Fax

Practice location:
  • Phone: 903-785-4362
  • Fax: 903-782-9365
Mailing address:
  • Phone: 903-785-4362
  • Fax: 903-782-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139214
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP139214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: