Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 35515 | TX |
Y | 213EG0000X | General Practice | 35515 | TX |
NPI | 1003460080 |
---|---|
Provider Name | Katie Wesneski Whitworth |
First Address | London, TX 76854-5600 |
Second Address | Brady, TX 76825-6229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/10/2020 |