Provider Demographics
NPI:1043692742
Name:BIXLER, WHITNEY NICOLE (ATC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:BIXLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:WHITNEY
Other - Middle Name:NICOLE
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3370 S COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7462
Mailing Address - Country:US
Mailing Address - Phone:417-839-3941
Mailing Address - Fax:
Practice Address - Street 1:3370 S COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7462
Practice Address - Country:US
Practice Address - Phone:417-839-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer