Provider Demographics
NPI:1043766074
Name:WHITENACK, STEPHANIE N (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:N
Last Name:WHITENACK
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, AGACNP
Mailing Address - Street 1:10007 HUEBNER RD STE 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1640
Mailing Address - Country:US
Mailing Address - Phone:210-692-0361
Mailing Address - Fax:210-593-4066
Practice Address - Street 1:10007 HUEBNER RD STE 402
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1640
Practice Address - Country:US
Practice Address - Phone:210-692-0361
Practice Address - Fax:210-593-4066
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737860163W00000X
TXAP131671363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse