Provider Demographics
NPI:1144216235
Name:WHITAKER, DARWIN PATRICK (PAC)
Entity Type:Individual
Prefix:MR
First Name:DARWIN
Middle Name:PATRICK
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CLEAR FORK BR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-6481
Mailing Address - Country:US
Mailing Address - Phone:606-216-8257
Mailing Address - Fax:
Practice Address - Street 1:234 BRENWOOD ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1637
Practice Address - Country:US
Practice Address - Phone:859-985-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS40011Medicare UPIN