Provider Demographics
NPI:1023773017
Name:WHITAKER, LOUVON
Entity type:Individual
Prefix:MRS
First Name:LOUVON
Middle Name:
Last Name:WHITAKER
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 1:1847 S 1ST ST APT 32
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-8862
Mailing Address - Country:US
Mailing Address - Phone:252-885-8870
Mailing Address - Fax:
Practice Address - Street 1:121 NASH ST W STE 121
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4012
Practice Address - Country:US
Practice Address - Phone:252-885-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC05Medicaid