Provider Demographics
NPI:1821480179
Name:GRUNDY, WHITNEY FULLER (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:FULLER
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 CLEARVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-7014
Mailing Address - Country:US
Mailing Address - Phone:361-318-9395
Mailing Address - Fax:
Practice Address - Street 1:1011 W GROVE ST
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1882
Practice Address - Country:US
Practice Address - Phone:361-318-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127096363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics