=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437073293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDI K. WHITLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2026
-----------------------------------------------------
Last Update Date | 08/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1356 COUNTY ROAD 1470
-----------------------------------------------------
City | BOGATA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75417-4719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-739-2424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1356 COUNTY ROAD 1470
-----------------------------------------------------
City | BOGATA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75417-4719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-739-2424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | 623883
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------