Provider Demographics
NPI:1760091003
Name:WHITLEY, RACHEL (AGNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 CARROLL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6311
Mailing Address - Country:US
Mailing Address - Phone:301-891-2500
Mailing Address - Fax:301-448-1679
Practice Address - Street 1:7610 CARROLL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6311
Practice Address - Country:US
Practice Address - Phone:301-891-2500
Practice Address - Fax:301-448-1679
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAG06200254363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty