Provider Demographics
NPI:1356820724
Name:WHITAKER, LINDA KAY (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 N NEW BRAUNFELS AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6358
Mailing Address - Country:US
Mailing Address - Phone:210-804-0193
Mailing Address - Fax:
Practice Address - Street 1:8610 N NEW BRAUNFELS AVE STE 405
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6358
Practice Address - Country:US
Practice Address - Phone:210-804-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607226163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid