Provider Demographics
NPI:1023038403
Name:WHITTAKER, DAVID MELVIN (APRN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MELVIN
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:MELVIN
Other - Last Name:WHITTAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1919 STATE ST STE 364
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6801
Mailing Address - Country:US
Mailing Address - Phone:812-949-4767
Mailing Address - Fax:812-948-4338
Practice Address - Street 1:1919 STATE ST STE 364
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6801
Practice Address - Country:US
Practice Address - Phone:812-949-4767
Practice Address - Fax:812-948-4338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002555363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health