Provider Demographics
NPI:1114905981
Name:WHALEY, LINDA BOSWELL (RN, MSN, GNP, ANP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BOSWELL
Last Name:WHALEY
Suffix:
Gender:F
Credentials:RN, MSN, GNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WELDON
Mailing Address - State:NC
Mailing Address - Zip Code:27890-1838
Mailing Address - Country:US
Mailing Address - Phone:252-537-1638
Mailing Address - Fax:
Practice Address - Street 1:704 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890-1838
Practice Address - Country:US
Practice Address - Phone:252-537-1638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600035363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201254OtherMEDCOST
NC7003736Medicaid
NC7230429OtherAETNA
NCS60114Medicare UPIN
NC2598181AMedicare PIN