Organization
KRISTY WHELAN D O P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY M WHELAN DO (OWNER)
(928) 680-3388
Entity
Organization
Contact information
Practice address
2082 MESQUITE AVE, SUITE 216, LAKE HAVASU CITY, AZ 86403-6710
(908) 680-4233
(928) 680-6522
Mailing address
PO BOX 645, LAKE HAVASU CITY, AZ 86405-0645
(908) 680-4233
(928) 680-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3773
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
701632001
—
AZ
01
—
AZ0422120
BCBS AZ
—
01
—
DE9062
RAILROAD MEDICARE
—
01
—
ZC9409
HEALTH NET
—
Enumeration date
12/11/2007
Last updated
03/12/2009
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