Provider Demographics
NPI:1154788479
Name:VIRGIL, WHITLEY (PA-C)
Entity type:Individual
Prefix:
First Name:WHITLEY
Middle Name:
Last Name:VIRGIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 COMMONS CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9524
Mailing Address - Country:US
Mailing Address - Phone:405-577-6700
Mailing Address - Fax:
Practice Address - Street 1:1804 COMMONS CIR
Practice Address - Street 2:SUITE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9524
Practice Address - Country:US
Practice Address - Phone:405-577-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant