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NPI Code Detail

MEDICARE: CORY MITCHELL WHITLOCK PAC

MEDICARE: CORY MITCHELL WHITLOCK PAC
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
12083P0500XPreventive Medicine/Occupational Environmental Medicine PhysicianPA1821NV
2390200000XStudent in an Organized Health Care Education/Training Program
3363A00000XPhysician AssistantPA1821NV

General Provider Information

NPI Number : 1205204781
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY MITCHELL WHITLOCK PAC
Provider Business Mailing Address
First Line : 427 BLACKRIDGE RD
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7632
Country : US
Telephone Number : 775-848-6971
Fax Number : 702-680-1377
Provider Business Practice Location Address
First Line : 2481 W HORIZON RIDGE PKWY STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5926
Country : US
Telephone Number : 775-848-6971
Fax Number : 702-680-1377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2015
Last Update Date : 05/01/2025

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