Provider Demographics
NPI:1104315902
Name:OOLEY, WHITNEY NICOLE (PA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:OOLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:NICOLE
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3626 GRANT LINE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-913-4091
Mailing Address - Fax:812-913-4069
Practice Address - Street 1:2108 STATE STREET
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-670-4305
Practice Address - Fax:812-725-1210
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant