Provider Demographics
NPI:1841511698
Name:WHITT, MANDY JONN (MD)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:JONN
Last Name:WHITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:JONN
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:9342 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-239-3228
Practice Address - Fax:502-231-2517
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN 15290207Q00000X
KY45723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100256480Medicaid
KY7100256480Medicaid