MEDICARE: AMI WHITLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	TBD	OK

General Provider Information

NPI Number	:	1013591676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMI WHITLEY

Provider Business Mailing Address
First Line	:	2725 SE 93RD ST
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-9167
Country	:	US
Telephone Number	:	405-249-5448
Fax Number	:

Provider Business Practice Location Address
First Line	:	9480 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:	405-876-7876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	06/07/2023

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Directions to “ AMI WHITLEY ” Practice Location

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