Provider Demographics
NPI:1598537094
Name:WHITLEY, KATHRYN HELEN (BS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HELEN
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3102
Mailing Address - Country:US
Mailing Address - Phone:407-878-2757
Mailing Address - Fax:407-288-8530
Practice Address - Street 1:165 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3102
Practice Address - Country:US
Practice Address - Phone:407-878-2757
Practice Address - Fax:407-288-8530
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula