Healthcare Provider Details

I. General information

NPI: 1164463774
Provider Name (Legal Business Name): LINDA P. WHITELEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HALIFAX ST
PETERSBURG VA
23803-6335
US

IV. Provider business mailing address

109 GOVERNOR STREET 3RD FLOOR
RICHMOND VA
23219
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-1652
  • Fax:
Mailing address:
  • Phone: 804-864-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168863
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: