MEDICARE: MR. JAMES VERNON WHITLEY 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	620929	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP110207	OTHER	TX	RN LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AP110207	OTHER	TX	APN LICENSE

General Provider Information

NPI Number	:	1962486852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES VERNON WHITLEY FNP

Provider Business Mailing Address
First Line	:	711 NAVARRO ST STE 600
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-1892
Country	:	US
Telephone Number	:	844-630-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4360 GRECO DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-2725
Country	:	US
Telephone Number	:	210-648-8200
Fax Number	:	855-392-7988

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

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	04/26/2018

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