Provider Demographics
NPI:1619470382
Name:MCCORMICK, WHITNEY ELIZABETH (FNP - C)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ELIZABETH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OAK ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1517
Mailing Address - Country:US
Mailing Address - Phone:304-544-0360
Mailing Address - Fax:304-453-1756
Practice Address - Street 1:750 OAK ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1517
Practice Address - Country:US
Practice Address - Phone:304-453-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN71214-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275379Medicaid
WV1619470382Medicaid
KY7100529190Medicaid