Healthcare Provider Details

I. General information

NPI: 1427138031
Provider Name (Legal Business Name): JUDITH WHITLEY MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS STE 203
ST THOMAS VI
00802-2687
US

IV. Provider business mailing address

9149 ESTATE THOMAS STE 203
ST THOMAS VI
00802-2687
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-8989
  • Fax: 340-776-8384
Mailing address:
  • Phone: 340-776-8989
  • Fax: 340-776-8384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5121
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: