1174975064 NPI number — DR. KATHRYN GROVES WHITTLE AU.D.

Table of content: DR. KATHRYN GROVES WHITTLE AU.D. (NPI 1174975064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174975064 NPI number — DR. KATHRYN GROVES WHITTLE AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTLE
Provider First Name:
KATHRYN
Provider Middle Name:
GROVES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUYKENDALL
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174975064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 SUMMER LEE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKWALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-771-5443
Provider Business Mailing Address Fax Number:
972-771-5444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
763 E US HIGHWAY 80
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
FORNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75126-8633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-771-5443
Provider Business Practice Location Address Fax Number:
972-771-5444
Provider Enumeration Date:
07/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  80883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com