Provider Demographics
NPI:1790988780
Name:WHITLEY, KEVIN JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JACKSON
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MURRAY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1039
Mailing Address - Country:US
Mailing Address - Phone:205-821-4230
Mailing Address - Fax:
Practice Address - Street 1:2575 BOYCE PLAZA RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3925
Practice Address - Country:US
Practice Address - Phone:412-257-2290
Practice Address - Fax:412-206-0217
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4518112084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry