Provider Demographics
NPI:1053299438
Name:WHITLEY, GABRIELLE RAE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:RAE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20220 BELLAIRE BLVD APT 5109
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3946
Mailing Address - Country:US
Mailing Address - Phone:832-535-8262
Mailing Address - Fax:
Practice Address - Street 1:20220 BELLAIRE BLVD APT 5109
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3946
Practice Address - Country:US
Practice Address - Phone:832-535-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty