Jacolby Thomas Whitaker
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Alto, TX
NPI 1164054482 · NPPES record last updated Feb 5, 2020
Key facts
- NPI
- 1164054482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 8830 State Highway 21
Alto, TX 75925-6018 - Phone
- (903) 948-1074
- NPI assigned
- Feb 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | TX | Yes |
Addresses
Primary practice location
8830 State Highway 21
Alto, TX 75925-6018
Mailing address
8830 State Highway 21
Alto, TX 75925-6018
Phone (903) 948-1074
Other providers in Alto, TX
All providers in Alto, TX · Student in an Organized Health Care Education/Training Program in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.