Provider Demographics
NPI:1841753654
Name:WHITEHURST, MICHAEL THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:WHITEHURST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2804 LANDON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27562-9309
Mailing Address - Country:US
Mailing Address - Phone:919-629-8679
Mailing Address - Fax:
Practice Address - Street 1:3001 EDWARDS MILL RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5243
Practice Address - Country:US
Practice Address - Phone:919-863-6856
Practice Address - Fax:919-863-6821
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08994363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant