Healthcare Provider Details

I. General information

NPI: 1487516167
Provider Name (Legal Business Name): WYKINNYA WHITEHURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2783 DARBYTOWN RD
HENRICO VA
23231-6006
US

IV. Provider business mailing address

2783 DARBYTOWN RD
HENRICO VA
23231-6006
US

V. Phone/Fax

Practice location:
  • Phone: 804-240-5661
  • Fax:
Mailing address:
  • Phone: 804-240-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: