Provider Demographics
NPI:1104057934
Name:WHITLEDGE, MOLLY ELIZABETH (RN)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:WHITLEDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-4364
Mailing Address - Country:US
Mailing Address - Phone:612-467-5881
Mailing Address - Fax:612-794-3990
Practice Address - Street 1:1715 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4364
Practice Address - Country:US
Practice Address - Phone:612-467-5881
Practice Address - Fax:612-794-3990
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1101254163WG0100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology