Provider Demographics
NPI:1427138031
Name:WHITLEY, JUDITH (MSN, FNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9149 ESTATE THOMAS STE 203
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2687
Mailing Address - Country:US
Mailing Address - Phone:340-776-8989
Mailing Address - Fax:340-776-8384
Practice Address - Street 1:9149 ESTATE THOMAS STE 203
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2687
Practice Address - Country:US
Practice Address - Phone:340-776-8989
Practice Address - Fax:340-776-8384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI5121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0055608Medicare ID - Type Unspecified
S58411Medicare UPIN