MEDICARE: BRENT WHITLEY APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP8187	AZ

General Provider Information

NPI Number	:	1316317704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT WHITLEY APRN

Provider Business Mailing Address
First Line	:	1801 E CAMELBACK ROAD
Second Line	:	SUITE 102, #1008
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	623-233-0914
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 N 7TH ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1850
Country	:	US
Telephone Number	:	623-233-0914
Fax Number	:	623-321-6050

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	06/03/2025

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