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NPI Code Detail

MEDICARE: LADELMA SHEREE WHITAKER

MEDICARE: LADELMA SHEREE WHITAKER
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
1302R00000XHealth Maintenance Organization
2302F00000XExclusive Provider Organization
3305R00000XPreferred Provider Organization
4305S00000XPoint of Service

General Provider Information

NPI Number : 1588089395
Entity Type Code : Individual
Provider Name (Legal Business Name) : LADELMA SHEREE WHITAKER
Provider Business Mailing Address
First Line : 2350 GOOSE BRANCH DR
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-9158
Country : US
Telephone Number : 252-469-0703
Fax Number :
Provider Business Practice Location Address
First Line : 2350 GOOSE BRANCH DR
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-9158
Country : US
Telephone Number : 252-469-0703
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2014
Last Update Date : 02/12/2026

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Directions to “ LADELMA SHEREE WHITAKER ” Practice Location

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