Provider Demographics
NPI:1063492429
Name:WHITESEL, HEATHER L (DPM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WHITESEL
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 1:740 S. LIMESTONE K-454
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-1293
Mailing Address - Fax:859-323-3823
Practice Address - Street 1:740 S. LIMESTONE K-454
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-1293
Practice Address - Fax:916-683-7290
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005829213E00000X
CAE4735213ES0103X
KY00357213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100103670Medicaid
PA1013619680Medicaid
PA093331LN1Medicare ID - Type UnspecifiedMEDICARE LEGACY NUMBER
PAV05963Medicare UPIN
V05963Medicare UPIN