Provider Demographics
NPI:1316049695
Name:MARTIN, WHITNEY C (PA-C, RD)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 S 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1914
Mailing Address - Country:US
Mailing Address - Phone:406-360-4228
Mailing Address - Fax:
Practice Address - Street 1:2875 TINA AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1326
Practice Address - Country:US
Practice Address - Phone:406-360-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MT676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered