Provider Demographics
NPI:1942218458
Name:WHICKER, JANICE PURGASON (MED)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:PURGASON
Last Name:WHICKER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3721
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603
Mailing Address - Country:US
Mailing Address - Phone:828-328-2966
Mailing Address - Fax:828-328-3336
Practice Address - Street 1:34 2ND ST NW
Practice Address - Street 2:SUITE 304
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-328-2966
Practice Address - Fax:828-328-3336
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133KGOtherBCBS NC
NC6105118Medicaid