Individual
JESSICA NICOLE WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
2315 BEL AIR RD, FALLSTON, MD 21047-2740
(443) 417-2499
Mailing address
1630 HONEYSUCKLE DR, FOREST HILL, MD 21050-2849
(978) 390-5019
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A0001012
MD
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/15/2016
Last updated
03/09/2021
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