Healthcare Provider Details

I. General information

NPI: 1982244109
Provider Name (Legal Business Name): JESSICA WHITNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 WASHINGTON BLVD
NEWCASTLE WY
82701-2968
US

IV. Provider business mailing address

1121 WASHINGTON BLVD
NEWCASTLE WY
82701-2968
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-6720
  • Fax:
Mailing address:
  • Phone: 307-746-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45285
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: