Individual provider Active NPI

Donna Marie Whitley, FNP-BC

  • Family Nurse Practitioner
  • Chesterfield, MO
National Provider Identifier
1851769418
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2015029820 Issued in MO
Practice address
15450 S Outer 40 Rd Ste 100
Chesterfield, MO 63017-2062
Phone
(636) 735-2000
NPI assigned
Sep 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2015029820 MO Primary

Addresses

Primary practice location

15450 S Outer 40 Rd Ste 100
Chesterfield, MO 63017-2062

Mailing address

15450 S Outer 40 Rd Ste 100
Chesterfield, MO 63017-2062
Phone (636) 735-2000

Other practice location 1

6500 Hospital Dr Ste 2B
Hannibal, MO 63401-6890
Phone (573) 629-3440

Other identifiers 1

IdentifierTypeStateIssuer
1851769418MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20150921002814 MO Practitioner - Nurse Practitioner 2668789868 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2015029820MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vpa PC CurrentSince Jan 1, 2024 Accepting new patients
Vpa PC CurrentSince Jan 1, 2024 Accepting new patients
Doctors on the Go1 L.C PastSince Jul 2, 2017 Accepting new patients

Locations

8706 Manchester Rd
Ste 106
Saint Louis, MO 63144
Phone (314) 961-3570

Interoperability endpoints

  • Direct secure messaging: ms_dwhitley@landmarkhealth-direct.org
  • Direct secure messaging: donna.whitley@768220391342084.direct.elationemr.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1851769418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15450 S OUTER 40 RD STE 100",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172062",
            "telephone_number": "636-735-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15450 S OUTER 40 RD STE 100",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172062",
            "telephone_number": "636-735-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 Hospital Dr Ste 2B",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634016890",
            "country_code": "US",
            "telephone_number": "573-629-3440",
            "fax_number": "573-629-3415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITLEY",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2015029820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851769418",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.