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General NPI Number Information
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NPI Number | 1396574380
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Entity Type | Individual
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Provider Name | KATHRYN WHITTAKER AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2024
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 5981 JEFFERSON ST NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3457
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Country | US
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Telephone | 505-370-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 5981 JEFFERSON ST NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3457
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Country | US
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Telephone | 505-370-9600
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Fax | 505-355-0566
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 55280
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License Number State | NM
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