Provider Demographics
| NPI: | 1760573158 |
|---|---|
| Name: | WHITESEL, FRANKIE LANE (PMHCNS,BC) |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | FRANKIE |
| Middle Name: | LANE |
| Last Name: | WHITESEL |
| Suffix: | |
| Gender: | F |
| Credentials: | PMHCNS,BC |
| Other - Prefix: | |
| Other - First Name: | FRANKIE |
| Other - Middle Name: | LANE |
| Other - Last Name: | WHITESEL |
| Other - Suffix: | |
| Other - Last Name Type: | Professional Name |
| Other - Credentials: | PMHCNS,BC |
| Mailing Address - Street 1: | 1481 W 10TH ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | INDIANAPOLIS |
| Mailing Address - State: | IN |
| Mailing Address - Zip Code: | 46202-2803 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 317-988-2388 |
| Mailing Address - Fax: | 317-988-3278 |
| Practice Address - Street 1: | 1481 W 10TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | INDIANAPOLIS |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 46202-2803 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 317-988-2388 |
| Practice Address - Fax: | 317-988-3278 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2006-09-28 |
| Last Update Date: | 2010-08-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| IN | 28077612A | 163W00000X |
| IN | 70000186A | 364S00000X, 364SP0809X, 364SP0811X, 364SP0812X, 364SP0813X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult |
| No | 163W00000X | Nursing Service Providers | Registered Nurse | |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | |
| No | 364SP0811X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Chronically Ill |
| No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community |
| No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IN | 100270530A | Medicaid | |
| IN | 100270530A | Medicaid |
