Basic Information
| Provider Information | |||||||||
| NPI: | 1780774984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRATT | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 W HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036546800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3201 W HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036546800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 629436 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 156391805 | 05 | TX | MEDICAID | 87965U | 01 | TX | BLUE CROSS | OTHER |