Provider Demographics
NPI:1245633015
Name:HARGRAVE, WHITNEY LAMONT (RN)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LAMONT
Last Name:HARGRAVE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9434 KATY FWY
Mailing Address - Street 2:STE 230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6378
Mailing Address - Country:US
Mailing Address - Phone:713-239-2399
Mailing Address - Fax:281-599-9190
Practice Address - Street 1:9434 KATY FWY
Practice Address - Street 2:STE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6378
Practice Address - Country:US
Practice Address - Phone:713-239-2399
Practice Address - Fax:281-599-9190
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770326163WC0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management