Provider Demographics
NPI:1285629717
Name:WHITEHURST, DEBORAH J (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:MN-109
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-1552
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:MN-109
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-1552
Practice Address - Fax:859-257-7799
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3451P363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78005352Medicaid