Provider Demographics
NPI:1669128104
Name:KATIE WHITAKER PMHNP-BC, LLC
Entity type:Organization
Organization Name:KATIE WHITAKER PMHNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP-BC
Authorized Official - Phone:802-552-0260
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05658-0131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3112
Practice Address - Country:US
Practice Address - Phone:802-552-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty