MEDICARE: CRISTINA MAY WHITT FNP

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	363LP2300X	Primary Care Nurse Practitioner	F04190587	VA
2	363LF0000X	Family Nurse Practitioner	0024178125	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F04190587	OTHER	VA	FAMILY NURSE PRACTITIONER LICENSE NUMBER

General Provider Information

NPI Number	:	1194385070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA MAY WHITT FNP

Provider Business Mailing Address
First Line	:	319 BROOKE ELYSE LN
Second Line	:
City	:	MAX MEADOWS
State	:	VA
Zip	:	24360-3547
Country	:	US
Telephone Number	:	276-245-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 1ST ST NW
Second Line	:
City	:	PULASKI
State	:	VA
Zip	:	24301-5605
Country	:	US
Telephone Number	:	540-980-0550
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	10/14/2019

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