Active NPI
Whitney M Werner, PA
- Physician Assistant
- Fortuna, CA
National Provider Identifier
1629011754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA52150
- Practice address
- 3304 Renner Dr
Fortuna, CA 95540-7102 - Phone
- (707) 725-9383
- Fax
- (707) 725-1140
- NPI assigned
- Jun 14, 2006
- Last updated
- Mar 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2158841206 | UT | |
| Physician Assistant | 363A00000X | PA52150 | CA | Primary |
Addresses
Primary practice location
3304 Renner Dr
Fortuna, CA 95540-7102
Mailing address
3304 Renner Dr
Fortuna, CA 95540-7102
Phone (707) 725-9383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 981727 | Other | UT | NATIONAL COMMISSION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52150 | CA | MD | Marriage & Family Therapist |
| PA52150 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1629011754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3304 RENNER DR",
"city": "FORTUNA",
"state": "CA",
"postal_code": "955407102",
"telephone_number": "707-725-9383",
"fax_number": "707-725-1140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3304 RENNER DR",
"city": "FORTUNA",
"state": "CA",
"postal_code": "955407102",
"telephone_number": "707-725-9383",
"fax_number": "707-725-1140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERNER",
"first_name": "WHITNEY",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "2158841206",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA52150",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL COMMISSION",
"identifier": "981727",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.