Provider Demographics
NPI:1932781648
Name:WHITTAKER, MATTHEW COLE (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:COLE
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1028
Mailing Address - Country:US
Mailing Address - Phone:606-207-2702
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST STE 248
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6804
Practice Address - Country:US
Practice Address - Phone:812-948-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant