Provider Demographics
NPI:1285783571
Name:WHELAN, TINA KNIGHT (PAC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:KNIGHT
Last Name:WHELAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1428
Mailing Address - Country:US
Mailing Address - Phone:434-947-3954
Mailing Address - Fax:
Practice Address - Street 1:2901 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1719
Practice Address - Country:US
Practice Address - Phone:434-947-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001558207RE0101X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA097991OtherANTHEM
P88423Medicare UPIN
C08317Medicare ID - Type Unspecified