Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | TBD | OK |
NPI | 1013591676 |
---|---|
Provider Name | Ami Whitley |
First Address | Moore, OK 73160-9167 |
Second Address | Oklahoma City, OK 73104-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2021 |
Last Update Date | 10/05/2021 |