Provider Demographics
NPI:1184643744
Name:WHITENER, PAMELA S (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:WHITENER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 GRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5912
Mailing Address - Country:US
Mailing Address - Phone:817-346-1925
Mailing Address - Fax:817-292-7237
Practice Address - Street 1:7001 GRANBURY RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5912
Practice Address - Country:US
Practice Address - Phone:817-346-1925
Practice Address - Fax:817-292-7237
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170739001Medicaid
TX170739003Medicaid
TX170739004Medicaid
TX170739002Medicaid
TX170739005Medicaid
TX8J9749Medicare PIN
TX170739003Medicaid
TXQ22854Medicare UPIN
TX170739005Medicaid
TXTXB105675Medicare PIN
TXTXB105681Medicare PIN