Provider Demographics
NPI:1518448422
Name:WHITVER, STEWART (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:WHITVER
Suffix:
Gender:M
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8244 GLASGOW ROAD ON THE LK
Mailing Address - Street 2:
Mailing Address - City:CASSADAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14718-9606
Mailing Address - Country:US
Mailing Address - Phone:716-680-1037
Mailing Address - Fax:
Practice Address - Street 1:200 E 3RD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5433
Practice Address - Country:US
Practice Address - Phone:716-661-8330
Practice Address - Fax:716-753-4230
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342445363LF0000X
NY402612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily