Provider Demographics
NPI:1356155725
Name:WHITAKER, MIRANDA L (APRN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-498-2815
Mailing Address - Fax:859-498-5669
Practice Address - Street 1:40 S BANK ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1322
Practice Address - Country:US
Practice Address - Phone:859-498-2815
Practice Address - Fax:859-298-5669
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4034089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily