MEDICARE: MISS WHITNEY MINTER HARRELL 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
1	363LF0000X	Family Nurse Practitioner	000	VA
2	363LF0000X	Family Nurse Practitioner	0024174968	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		0

General Provider Information

NPI Number	:	1619404282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS WHITNEY MINTER HARRELL FNP

Provider Business Mailing Address
First Line	:	95 MINTER FARM LN
Second Line	:
City	:	AXTON
State	:	VA
Zip	:	24054-3694
Country	:	US
Telephone Number	:	434-688-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3447
Country	:	US
Telephone Number	:	276-670-3300
Fax Number	:

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

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	10/30/2019

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