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General NPI Number Information
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NPI Number | 1609695378
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Entity Type | Organization
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Legal Business Name | WHITAKER DIRECT PRIMARY CARE, LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 401 N MAIN ST
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City | ARCANUM
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State | OH
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Zip | 45304-1332
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Country | US
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Telephone | 937-662-0191
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Fax | 937-662-0199
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Provider Business Mailing Address
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Address Line | 401 N MAIN ST
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City | ARCANUM
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State | OH
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Zip | 45304-1332
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Country | US
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Telephone | 937-662-0191
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Fax | 937-662-0199
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Authorized Official
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Title or Position | OWNER
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Name | ABBY WHITAKER
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Credential | APRN-CNP
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Telephone | 937-662-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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