| Brandon Lane Whitlock, AG-ACNP | |
|
1119 Highland Ave Ste 7, Clarkston, WA 99403-2836 | |
| (509) 758-1119 | |
| Not Available |
| Full Name | Brandon Lane Whitlock |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 5 Years |
| Location | 1119 Highland Ave Ste 7, Clarkston, Washington |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124353719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 65287 (Idaho) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | AP61081911 (Washington) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Elite Home Health | Clarkston, WA | Home health agency |
| Advanced Home Care Of Coeur D'alene | Coeur d'alene, ID | Home health agency |
| Tri-state Memorial Hospital | Clarkston, WA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Tri-state Memorial Hospital | 4082502422 | 26 |
| Meza Post Acute And Long Term Care Pllc | 4981028503 | 26 |
| Tri-state Memorial Hospital | 4082502422 | 26 |
| Entity Name | Tri-state Memorial Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598814352 PECOS PAC ID: 4082502422 Enrollment ID: O20040911000031 |
| Entity Name | Sound Physicians Of Idaho |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1730407461 PECOS PAC ID: 4688705346 Enrollment ID: O20100624000921 |
| Entity Name | Meza Post Acute And Long Term Care Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932725215 PECOS PAC ID: 4981028503 Enrollment ID: O20200715002977 |
| Entity Name | Vannvei Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1881200517 PECOS PAC ID: 1254743420 Enrollment ID: O20201211000338 |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon Lane Whitlock, AG-ACNP Po Box 189, Clarkston, WA 99403-0189 Ph: (509) 758-1119 | Brandon Lane Whitlock, AG-ACNP 1119 Highland Ave Ste 7, Clarkston, WA 99403-2836 Ph: (509) 758-1119 |
Jennifer Lynn Nicholas, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1433 5th St, Clarkston, WA 99403 Phone: 509-758-5141 Fax: 509-758-5299 | |
Laure M Larsen, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1119 Highland Ave, Clarkston, WA 99403 Phone: 509-780-4450 Fax: 509-758-3700 | |
Brian Francis Ciezki, ACNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1625 5th St, Clarkston, WA 99403 Phone: 509-295-8398 Fax: 509-295-8416 | |
Angel D Klippenstein, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 808 Port Dr, Clarkston, WA 99403 Phone: 208-298-0720 Fax: 208-298-0727 | |
Charmaine R Allen-johnson, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 619 Diagonal St, Clarkston, WA 99403 Phone: 509-758-9003 Fax: 509-758-9001 | |
Todd M Carpenter, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1268 Bridge St, Clarkston, WA 99403 Phone: 509-758-9524 Fax: 509-758-8258 |