Provider Demographics
NPI:1316215064
Name:WILHITE, CORY R (CRNP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:R
Last Name:WILHITE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 GUILLARD RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:PA
Mailing Address - Zip Code:16052-2702
Mailing Address - Country:US
Mailing Address - Phone:724-496-6757
Mailing Address - Fax:
Practice Address - Street 1:120 ADAMS LN
Practice Address - Street 2:
Practice Address - City:PORTERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16051-2419
Practice Address - Country:US
Practice Address - Phone:724-368-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP011742OtherLICENSE