MEDICARE: COURTNEY WHITAKER PMHNP

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	164W00000X	Licensed Practical Nurse	LPN059204	GA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN296651	GA

General Provider Information

NPI Number	:	1255544581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY WHITAKER PMHNP

Provider Business Mailing Address
First Line	:	5300 WOODRUFF FARM RD APT 68
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-1360
Country	:	US
Telephone Number	:	706-366-9473
Fax Number	:

Provider Business Practice Location Address
First Line	:	6003 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6200
Country	:	US
Telephone Number	:	706-223-1933
Fax Number	:	706-223-1934

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	12/12/2024

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