Provider Demographics
NPI:1962975664
Name:WHITAKER, THURITHABHANI UDATHARI (CRNA)
Entity type:Individual
Prefix:
First Name:THURITHABHANI
Middle Name:UDATHARI
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:THURITHABHANI
Other - Middle Name:
Other - Last Name:MAECHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4428
Mailing Address - Country:US
Mailing Address - Phone:479-212-1538
Mailing Address - Fax:
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC003266207L00000X
TN124642207L00000X
KY3015692367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology