Provider Demographics
NPI:1962486852
Name:WHITLEY, JAMES VERNON (FNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VERNON
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NAVARRO ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1892
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:
Practice Address - Street 1:4360 GRECO DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-2725
Practice Address - Country:US
Practice Address - Phone:210-648-8200
Practice Address - Fax:855-392-7988
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP110207OtherRN LICENSE
TX149615004Medicaid
TXAP110207OtherAPN LICENSE
TXAP110207OtherAPN LICENSE