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General NPI Number Information
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NPI Number | 1205870649
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Entity Type | Individual
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Provider Name | LARRY KEITH WHITAKER JR. P.A.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 801 E ORANGE ST HOOPESTON COMMUNITY MEMORIAL HOSPITAL DBA CHARLOTTE ANN
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City | HOOPESTON
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State | IL
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Zip | 60942-1802
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Country | US
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Telephone | 217-283-5644
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Fax | 217-283-7432
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Provider Business Mailing Address
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Address Line | 611 W PARK ST BWPC
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City | URBANA
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State | IL
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Zip | 61801-2500
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Country | US
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Telephone | 217-383-6792
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002299
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085002299
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License Number State | IL
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