Provider Demographics
NPI:1174275523
Name:WHITAKER, TWYLA DENICE
Entity Type:Individual
Prefix:
First Name:TWYLA
Middle Name:DENICE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-5028
Mailing Address - Country:US
Mailing Address - Phone:940-337-6521
Mailing Address - Fax:
Practice Address - Street 1:2707 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-5028
Practice Address - Country:US
Practice Address - Phone:940-337-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX842522163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical