=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164454088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEYNA JURI WHITNEY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73153 MILITARY RD
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70435-6054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-6133
-----------------------------------------------------
Fax | 985-626-6136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13675 COURSEY BLVD APT. 1525
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70817-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-751-8165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 200566
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------