Healthcare Provider Details

I. General information

NPI: 1659530046
Provider Name (Legal Business Name): WHITAKER NATIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 ALDERSON ST
WILLIAMSON WV
25661-3215
US

IV. Provider business mailing address

PO BOX 409013
ATLANTA GA
30384-9013
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-2500
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MOORE
Title or Position: CFO
Credential:
Phone: 415-435-4591