Provider Demographics
NPI:1306380019
Name:FALLON, WHITNEY (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19416 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9807
Mailing Address - Country:US
Mailing Address - Phone:502-882-0176
Mailing Address - Fax:
Practice Address - Street 1:13000 EQUITY PL STE 105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3976
Practice Address - Country:US
Practice Address - Phone:502-882-0176
Practice Address - Fax:502-234-9225
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010737363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily