Provider Demographics
NPI:1902056641
Name:WHITEHEAD, CLAIRE (RN, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:RN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14825 BEAR CREEK PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8937
Mailing Address - Country:US
Mailing Address - Phone:512-739-8805
Mailing Address - Fax:
Practice Address - Street 1:1165 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3152
Practice Address - Country:US
Practice Address - Phone:512-804-3465
Practice Address - Fax:512-692-3903
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116980363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208665402Medicaid
TX567904YMGJOtherMEDICARE
TX831N53OtherBCBS
TX208665403Medicaid
TX208665404Medicaid
TX208665404Medicaid
TX567904YMGJOtherMEDICARE