Provider Demographics
NPI:1619404282
Name:HARRELL, WHITNEY MINTER (FNP)
Entity type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:MINTER
Last Name:HARRELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MINTER FARM LN
Mailing Address - Street 2:
Mailing Address - City:AXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24054-3694
Mailing Address - Country:US
Mailing Address - Phone:434-688-8094
Mailing Address - Fax:
Practice Address - Street 1:1627 SEYMOUR DR
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3447
Practice Address - Country:US
Practice Address - Phone:276-670-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA000363LF0000X
VA0024174968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0