Provider Demographics
NPI:1760091003
Name:WHITLEY, RACHEL (AGNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 ANNAPOLIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1622
Mailing Address - Country:US
Mailing Address - Phone:106-722-2554
Mailing Address - Fax:410-816-9472
Practice Address - Street 1:1130 ANNAPOLIS RD STE 100
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1622
Practice Address - Country:US
Practice Address - Phone:410-672-2255
Practice Address - Fax:410-816-9472
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAG06200254363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty