Provider Demographics
NPI:1629308457
Name:WHITLOCK, RALPH JR (RN)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:
Last Name:WHITLOCK
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:BUDDY
Other - Middle Name:
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:101 TIVOLI LN
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7459
Mailing Address - Country:US
Mailing Address - Phone:501-580-7827
Mailing Address - Fax:
Practice Address - Street 1:21 BRIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9514
Practice Address - Country:US
Practice Address - Phone:501-771-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR45035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse