Provider Demographics
NPI:1427416254
Name:WHITWELL, TERESA MICHELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MICHELLE
Last Name:WHITWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 RICHARDS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2650
Mailing Address - Country:US
Mailing Address - Phone:501-255-3995
Mailing Address - Fax:501-907-0623
Practice Address - Street 1:819 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3349
Practice Address - Country:US
Practice Address - Phone:501-778-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily