Provider Demographics
NPI:1952841587
Name:WHITMIRE, JARED (MED, MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:WHITMIRE
Suffix:
Gender:M
Credentials:MED, MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6799
Mailing Address - Country:US
Mailing Address - Phone:817-547-7506
Mailing Address - Fax:
Practice Address - Street 1:5201 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6799
Practice Address - Country:US
Practice Address - Phone:817-547-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer