Provider Demographics
NPI:1386119857
Name:WHITAKER, KRISTA RAYLYNN (NP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RAYLYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1128 CLARKSVILLE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6089
Mailing Address - Country:US
Mailing Address - Phone:903-785-4362
Mailing Address - Fax:903-782-9365
Practice Address - Street 1:1128 CLARKSVILLE ST STE 100
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6089
Practice Address - Country:US
Practice Address - Phone:903-785-4362
Practice Address - Fax:903-782-9365
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139214363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily