Jacolby Thomas Whitaker
Student in an Organized Health Care Education/Training Program in Alto, TX. Individual provider (NPI-1).
NPI number1164054482
StatusActive
Last updated in NPPESFeb 5, 2020
Details
- NPI
- 1164054482
- Entity type
- Individual (NPI-1)
- Name
- Jacolby Thomas Whitaker
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 5, 2020
- Certification date
- Feb 5, 2020
- Last updated
- Feb 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | TX | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
8830 State Highway 21Alto, TX 75925-6018
Phone 903-948-1074
Mailing address
8830 State Highway 21Alto, TX 75925-6018
Phone 903-948-1074
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