Provider Demographics
NPI:1063697472
Name:WHITENTON, KRISTI (DO)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:WHITENTON
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:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-455-4458
Mailing Address - Fax:034-551-6049
Practice Address - Street 1:3005 JOE RAMSEY BLVD E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7714
Practice Address - Country:US
Practice Address - Phone:903-455-4458
Practice Address - Fax:903-455-1604
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K3247Medicare PIN