Provider Demographics
NPI:1790189272
Name:WHALEY, PATRICIA A (PMHNP, FNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:WHALEY
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1367
Mailing Address - Country:US
Mailing Address - Phone:573-547-3116
Mailing Address - Fax:
Practice Address - Street 1:12 N KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1367
Practice Address - Country:US
Practice Address - Phone:573-547-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014036363363LF0000X
MO2023048915363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO1790189272Medicaid