Provider Demographics
NPI:1689926115
Name:WHITACRE, INA (PA-C)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:
Last Name:WHITACRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2017
Mailing Address - Country:US
Mailing Address - Phone:816-559-6369
Mailing Address - Fax:816-559-6368
Practice Address - Street 1:920 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-2017
Practice Address - Country:US
Practice Address - Phone:816-559-6359
Practice Address - Fax:816-559-6368
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012035063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant