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NPI Code Detail

MEDICARE: MARY WHITMAN FNP

MEDICARE: MARY WHITMAN 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
1363L00000XNurse Practitioner094867MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194710764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY WHITMAN FNP
Provider Business Mailing Address
First Line : PO BOX 777
Second Line :
City : RICHLAND
State : MO
Zip : 65556-0777
Country : US
Telephone Number : 877-406-2662
Fax Number :
Provider Business Practice Location Address
First Line : 1501 SCHOOL RD
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9761
Country : US
Telephone Number : 877-406-2662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 05/17/2022

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