Provider Demographics
NPI:1427643816
Name:WHITNEY, ANTHONY GREGORY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GREGORY
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8355 COZUMEL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4689
Mailing Address - Country:US
Mailing Address - Phone:702-824-2385
Mailing Address - Fax:
Practice Address - Street 1:3841 W CHARLESTON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1858
Practice Address - Country:US
Practice Address - Phone:661-302-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV837654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily