Provider Demographics
NPI:1518552090
Name:REARDON, WHITNEY J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:J
Last Name:REARDON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 APPLE WYRICK RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-8843
Mailing Address - Country:US
Mailing Address - Phone:336-552-5291
Mailing Address - Fax:
Practice Address - Street 1:1107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5313
Practice Address - Country:US
Practice Address - Phone:336-951-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014180207RE0101X, 363LF0000X
NCREAR-Z5J8E207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism