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Individual

KELLI K WHITAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
6621 FANNIN ST, HOUSTON, TX 77030-2358
(225) 939-4437
Mailing address
9118 BLUEBONNET CENTRE BLVD, BATON ROUGE, LA 70809-2993
(225) 368-2347
(225) 368-2280

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
A10195
LA
363AM0700X
Medical Physician Assistant
Primary
PA12104
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1625868
LA
Enumeration date
10/24/2005
Last updated
01/23/2020
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