Provider Demographics
NPI:1942266069
Name:WHITNEY, JEANNETTE
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JEANNETTE
Other - Middle Name:WHITNEY
Other - Last Name:IGLESIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3525 DOROTHY LN S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1731
Mailing Address - Country:US
Mailing Address - Phone:817-763-0233
Mailing Address - Fax:817-763-0233
Practice Address - Street 1:3525 DOROTHY LN S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1731
Practice Address - Country:US
Practice Address - Phone:817-763-0233
Practice Address - Fax:817-763-0233
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ46112080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine