Stephanie P Whitlock, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP61601853 Issued in WA

Practice address

1119 Highland Ave Ste 10
Clarkston, WA 99403-2836

Phone

(509) 758-1450

NPI assigned

Aug 27, 2024

Last updated

Aug 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1598814352
  Medicare reassignment NPD
• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1760485221
  Medicare reassignment NPD
• Tri-State Memorial Hospital

  • Community Based Hospice Care Agency
  • Clarkston, WA
  • NPI 1831100254
  NPD
• Tri-State Memorial Hospital

  dba Tri State Medical Clinics

  • Family Medicine Physician
  • Clarkston, WA
  • NPI 1932405693
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1336973908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3814 13TH STREET D",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835015704",
            "telephone_number": "208-305-0742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 HIGHLAND AVE STE 10",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032836",
            "telephone_number": "509-758-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITLOCK",
        "first_name": "STEPHANIE",
        "middle_name": "P",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WA",
            "license": "AP61601853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Jean Weiss, DC
• Julian Welz
• Cynthia Jean Wendt, PHARMACIST
• Newton Kirke White, MD
• Brandon Lane Whitlock, AG-ACNP
• Daniel Whittlesey, DDS
• Lear Anthony Wickens, RPH
• Dana Majors Wiggins
• Amanda Wilkins
• Brandi Williams

• Gerontology Nurse Practitioner in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Gerontology Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.