Wholelife Authentic Care Provider Network

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

WHOLELIFE AUTHENTIC CARE PROVIDER NETWORK

Practice address

1000 Bonnie Brae Ave Ste 120
Fort Worth, TX 76111-4301

Phone

(817) 706-3128

NPI assigned

May 10, 2019

Organization subpart

No

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

Authorized official

Name

Nicole Havrilla

Title

Board President

Phone

(806) 220-6455

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20064/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristi Renea King, M.D.

  • Obstetrics & Gynecology Physician
  • Fort Worth, TX
  • NPI 1740579150
  NPD (past)

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

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1386200889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11043",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761100043",
            "telephone_number": "817-706-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BONNIE BRAE AVE STE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761114301",
            "telephone_number": "817-706-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHOLELIFE AUTHENTIC CARE PROVIDER NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "HAVRILLA",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "806-220-6455"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tricia L Whitson, CRNA
• Sarah Noll Whitt, PT, DPT, OCS, ATC/L
• Taylor Nicole Whitten
• James Eric Whitworth, P.A.
• Mary S Whitworth, MD
• Wholistic Midwifery
• Maximillian Whooley, MD
• Amanda Kay Whorton, RT (R)(CT)
• Katherine Wickersham
• Clarissa Wicklund, LMFT

• General Practice Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.