Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3002555 | KY |
NPI | 1023038403 |
---|---|
Provider Name | Mr. David Melvin Whittaker |
First Address | New Albany, IN 47150-6801 |
Second Address | New Albany, IN 47150-6801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 21/08/2016 |