Provider Demographics
NPI:1841635745
Name:WHITT, KATHIE J (DPM)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:J
Last Name:WHITT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2801
Mailing Address - Country:US
Mailing Address - Phone:319-233-6107
Mailing Address - Fax:319-233-9138
Practice Address - Street 1:927 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2801
Practice Address - Country:US
Practice Address - Phone:319-233-6107
Practice Address - Fax:319-233-9138
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080571213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery