Provider Demographics
NPI:1538714738
Name:OLIVER, WHITNEY LEE (PA-C)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1102 NW LOWES AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8093
Mailing Address - Country:US
Mailing Address - Phone:479-254-8563
Mailing Address - Fax:479-254-8564
Practice Address - Street 1:1102 NW LOWES AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-8093
Practice Address - Country:US
Practice Address - Phone:792-254-8563
Practice Address - Fax:479-254-8564
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARPA-963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program