Basic Information
| Provider Information | |||||||||
| NPI: | 1962486852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITLEY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | VERNON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 NAVARRO ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782051892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446300700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4360 GRECO DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782222725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106488200 | ||||||||
| FaxNumber: | 8553927988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2005 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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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 | 363LF0000X | 620929 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP110207 | 01 | TX | RN LICENSE | OTHER | 149615004 | 05 | TX | MEDICAID | AP110207 | 01 | TX | APN LICENSE | OTHER |