Provider Demographics
NPI:1285202440
Name:HALL, WHITNEY
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:HALL
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 1:668 E SHORTS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IN
Mailing Address - Zip Code:47165-8743
Mailing Address - Country:US
Mailing Address - Phone:502-396-1178
Mailing Address - Fax:
Practice Address - Street 1:668 E SHORTS CORNER RD
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IN
Practice Address - Zip Code:47165-8743
Practice Address - Country:US
Practice Address - Phone:502-396-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2020131277207QA0505X
IN71011860A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine