Provider Demographics
NPI:1831271246
Name:WHITEAKER, ADRIAN L (CRNA)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:L
Last Name:WHITEAKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E LAMAR BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7353
Mailing Address - Country:US
Mailing Address - Phone:817-861-3994
Mailing Address - Fax:817-861-3926
Practice Address - Street 1:2000 E LAMAR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7353
Practice Address - Country:US
Practice Address - Phone:817-861-3994
Practice Address - Fax:817-861-3926
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235831367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088793701Medicaid
TX088793701Medicaid