Provider Demographics
NPI:1184873127
Name:WHATLEY, AUDRA (LAC)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2504 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2746
Mailing Address - Country:US
Mailing Address - Phone:214-551-4734
Mailing Address - Fax:972-540-9044
Practice Address - Street 1:490 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:214-551-4734
Practice Address - Fax:972-540-9044
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC#00745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist