Healthcare Provider Details

I. General information

NPI: 1285783571
Provider Name (Legal Business Name): TINA KNIGHT WHELAN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 LANGHORNE RD
LYNCHBURG VA
24501-1719
US

IV. Provider business mailing address

2091 LANGHORNE RD
LYNCHBURG VA
24501-1428
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3954
  • Fax:
Mailing address:
  • Phone: 434-947-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001558
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0110001558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: