Individual
DR. JEFFREY DANIEL WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, PMHNP-BC
Contact information
Practice address
1201 SW 12TH AVE, PORTLAND, OR 97205-2046
(971) 251-9856
Mailing address
1446A 5TH AVE, FORT KNOX, KY 40121-2223
(903) 283-0834
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202213055NP-PP
OR
Other
Enumeration date
09/19/2022
Last updated
09/19/2022
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