Provider Demographics
NPI:1376135111
Name:SMITH, WHITNEY MARIA
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MARIA
Last Name:SMITH
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 1:322 GOLDSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4834
Mailing Address - Country:US
Mailing Address - Phone:605-254-8655
Mailing Address - Fax:
Practice Address - Street 1:1509 DOCTORS CIR BLDG C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-662-7500
Practice Address - Fax:910-662-7501
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014037363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner