Provider Demographics
NPI:1053890012
Name:WHITACRE, KATIE LYN (NP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYN
Last Name:WHITACRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PORTAGE TRL STE A
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3055
Mailing Address - Country:US
Mailing Address - Phone:330-808-1664
Mailing Address - Fax:330-208-0378
Practice Address - Street 1:600 PORTAGE TRL STE A
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3055
Practice Address - Country:US
Practice Address - Phone:330-808-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH023437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH023437OtherNPPES