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General NPI Number Information
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NPI Number | 1033212386
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Entity Type | Individual
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Provider Name | VAN CARROL WHITMIRE MHS, ATC, LAT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 BREVARD COLLEGE DRIVE
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City | BREVARD
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State | NC
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Zip | 28712-0000
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Country | US
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Telephone | 828-884-8346
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Fax | 828-884-8269
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Provider Business Mailing Address
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Address Line | 128 JETER MOUNTAIN RD
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City | PENROSE
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State | NC
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Zip | 28766-8771
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Country | US
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Telephone | 828-862-8221
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Fax | 828-884-8269
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0283
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License Number State | NC
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