Provider Demographics
NPI:1366206989
Name:WHITELY, MONIQUE (PA-C)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:WHITELY
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 1:2002 HOLCOMBE BLVD # 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:713-794-7375
Mailing Address - Fax:713-383-1211
Practice Address - Street 1:2002 HOLCOMBE BLVD # 110
Practice Address - Street 2:ATTN: GERIATRICS CLINIC
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-7375
Practice Address - Fax:713-383-1211
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant