Healthcare Provider Details

I. General information

NPI: 1336050400
Provider Name (Legal Business Name): WHISTLE STOP PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E GOODE ST STE F
QUITMAN TX
75783-2504
US

IV. Provider business mailing address

407 CONGER ST
QUITMAN TX
75783-2322
US

V. Phone/Fax

Practice location:
  • Phone: 903-287-6582
  • Fax: 430-287-2741
Mailing address:
  • Phone: 903-287-6582
  • Fax: 430-287-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY SMITH HARGROVE
Title or Position: OWNER/PROVIDER
Credential: APRN, CPNP-PC
Phone: 903-312-8575