Provider Demographics
NPI:1457000135
Name:WHITED, NOAH LYONS
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:LYONS
Last Name:WHITED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 WINDEMERE WAY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5210
Mailing Address - Country:US
Mailing Address - Phone:817-629-6964
Mailing Address - Fax:
Practice Address - Street 1:788 WINDEMERE WAY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5210
Practice Address - Country:US
Practice Address - Phone:817-629-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program