Provider Demographics
NPI:1841566023
Name:WHITMORE, JENNIFER LINDSAY (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDSAY
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:321 N NELLIS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5416
Practice Address - Country:US
Practice Address - Phone:702-438-4003
Practice Address - Fax:702-438-0555
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203793207R00000X
NVDO2579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1841566023Medicaid
NVDO2579OtherSTATE LICENSE
VA0102203793OtherVIRGINIA MEDICAL LICENSE