Kent B Whitaker, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

105103-1206 Issued in UT

Practice address

550 E 1400 N
Suite R
Logan, UT 84341-2406

Phone

(435) 755-9484

Fax

(435) 755-2832

NPI assigned

Nov 7, 2005

Sex

Male

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 UT

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

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kent.whitaker.1@13153.direct.athenahealth.com
• FHIR API: https://fhir4.healow.com/fhir/r4/IGBGAA/Endpoint/IGBGAA

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

• Kelly W Hubbard MD PC

  • Dermatology Physician
  • Logan, UT
  • NPI 1770779985
  Medicare reassignment

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1487635579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 E 1400 N",
            "address_2": "STE R",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412406",
            "telephone_number": "435-755-9484",
            "fax_number": "435-755-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E 1400 N",
            "address_2": "SUITE R",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412406",
            "telephone_number": "435-755-9484",
            "fax_number": "435-755-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "KENT",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "105103-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Western Intermountain Lithotripsy
• Westmed Pharmacy
• Reta Whalen, LCSW
• Dennis Wheatley, LMFT
• Erin Elizabeth Wheatley, M.ED., BCBA, LBA
• Joshua Lee Whitcomb
• Angie Nye White, CMHC
• Cynthia C White, CD
• Nolan A White, D.C.
• Taylor Anne White

• Physician Assistant in Logan, UT
• Providers in Logan, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.