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General NPI Number Information
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NPI Number | 1780447854
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Entity Type | Individual
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Provider Name | DAMOND WHITAKER NP
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Gender | Male
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 110 N ROBINSON ST STE 200
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City | RICHMOND
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State | VA
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Zip | 23220-4460
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Country | US
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Telephone | 804-367-3777
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Fax | 804-367-4209
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Provider Business Mailing Address
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Address Line | 110 N ROBINSON ST
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City | RICHMOND
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State | VA
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Zip | 23220-4459
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Country | US
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Telephone | 804-367-3777
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Fax | 804-367-4209
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024186872
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License Number State | VA
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