=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326513268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TREVOR DYLAN WHIPKER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2018
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4010 W GOELLER BLVD STE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47201-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-964-5056
-----------------------------------------------------
Fax | 888-571-6064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6047 CHINKAPIN DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47201-8447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-374-8389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F08181163
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------