Provider Demographics
NPI:1912228305
Name:HARRISON, WHITNEY SLACK (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:SLACK
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:WHITNEY
Other - Middle Name:CATHERINE
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:4687 POUNCEY TRACT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5802
Mailing Address - Country:US
Mailing Address - Phone:804-422-5437
Mailing Address - Fax:
Practice Address - Street 1:7023 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4126
Practice Address - Country:US
Practice Address - Phone:804-320-1353
Practice Address - Fax:804-320-6636
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168842363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics