Individual
WHITNEY NICOLE THOMAS SHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.- C
Contact information
Practice address
232 S WOODS MILL RD STE 400E, CHESTERFIELD, MO 63017-3406
(314) 878-2888
(314) 576-8187
Mailing address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
(704) 335-8448
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01840
NC
363A00000X
Physician Assistant
Primary
2020009409
MO
363AS0400X
Surgical Physician Assistant
0010-01840
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326281130
—
NC
01
—
2342616
MEDICARE GROUP PTAN
NC
01
—
2760123
MEDICARE PTAN
NC
Enumeration date
04/08/2009
Last updated
07/07/2022
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