Provider Demographics
NPI:1790369189
Name:WHITNEY, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120791 S 4090 RD
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-3383
Mailing Address - Country:US
Mailing Address - Phone:918-618-3551
Mailing Address - Fax:
Practice Address - Street 1:120791 S 4090 RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3383
Practice Address - Country:US
Practice Address - Phone:918-618-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency