Provider Demographics
NPI:1871317321
Name:WHITT, DARRELL
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:WHITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-1114
Mailing Address - Country:US
Mailing Address - Phone:314-437-0352
Mailing Address - Fax:314-437-0352
Practice Address - Street 1:2318 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-1114
Practice Address - Country:US
Practice Address - Phone:314-437-0352
Practice Address - Fax:314-437-0352
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty