Basic Information
| Provider Information | |||||||||
| NPI: | 1457824799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITLEY | ||||||||
| FirstName: | CLINTON | ||||||||
| MiddleName: | HARRIS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CRNA, DNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WHITLEY | ||||||||
| OtherFirstName: | CLINT | ||||||||
| OtherMiddleName: | H | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1010 HAMPTON FALL BLVD APT 1101 | ||||||||
| Address2: | |||||||||
| City: | BROWNSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357418025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013104102 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 SIVLEY RD SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562651000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2019 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-172791 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.