WHITLEY BROOK SEPULVEDA (NPI# 1790202414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790202414 |
| Entity Type | Individual |
| Full Name | WHITLEY BROOK SEPULVEDA |
| Practice Address |
833 Fort Gates Waco TX 76708-9740 |
| Practice Telephone | 2547226073 |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2017-08-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
833 FORT GATES |
| City | WACO |
| State | TX |
| Zip Code | 76708-9740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144868613 | Sarah Bogacz | Behavior Technician | 6824 Logue Lane, Bluesprig Pediatrics, Waco, TX 76708 | 2019-12-16 |
| 1700358215 | Albert Jacob Puente | Specialist/Technologist | 1101 North Q Ave, Clifton, TX 76708 | 2018-12-21 |
| 1437414810 | Cenikor Foundation | Substance Abuse Rehabilitation Facility | 3015 Herring Avenue, Waco, TX 76708 | 2012-07-11 |
| 1922393610 | Betty Hendricks | Nurse Practitioner | 4601 N 19th Street, Waco, TX 76708 | 2011-06-10 |
| 1023239498 | Esc Iv, Lp | Assisted Living Facility | 3801 Martin Luther King Jr Bvd, Waco, TX 76708 | 2007-05-01 |
| 1952429367 | Dod David Moore | Dentist | 10104 Saddle Creek Rd, Waco, TX 76708 | 2007-03-26 |
| 1851400295 | H-e-b, Lp | Clinical Medical Laboratory | 3801 N 19th St, Waco, TX 76708 | 2006-08-30 |
| 1972527257 | Meryl Burchardt | Nurse Practitioner | 2201 Macarthur, Suite 2200, Waco, TX 76708 | 2006-07-27 |
| 1669493292 | Central Texas Anesthesiology Associates Inc | Anesthesiology | 3000 Herring, Waco, TX 76708 | 2006-07-21 |
| 1679507768 | Russell L Mcclellan | Radiology | 3000 Herring Avenue, Waco, TX 76708 | 2006-07-11 |
| Find all providers in zip 76708 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881827624 | Jessica Jean Layden | Student in an Organized Health Care Education/Training Program | 1 Bear Pl Unit 97313, Waco, TX 76798-7313 | 2009-08-27 |
| 1609498385 | Marc Levi Johnson | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2020-05-15 |
| 1982230132 | Stephanie Perko | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2020-03-19 |
| 1346807781 | Irfan Shaik | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2019-05-21 |
| 1679032452 | Jack Kelly | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2019-03-19 |
| 1912491705 | Mir Quasim Ali Saad Naseri | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2018-06-15 |
| 1922502780 | Latashua Joseph | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2018-03-19 |
| 1194254714 | Austin Revvie Green | Student in an Organized Health Care Education/Training Program | 7911 Woodway Dr, Waco, TX 76712-3866 | 2017-06-07 |
| 1407214844 | Pan Chang | Student in an Organized Health Care Education/Training Program | 609 Elm St, Waco, TX 76704-2516 | 2016-01-30 |
| 1508281429 | Dawna Campbell | Student in an Organized Health Care Education/Training Program | 1105 Wooded Acres Dr, Suite 545, Waco, TX 76710-4468 | 2014-02-28 |
| Find all providers in WACO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.