| Doctor Name: | DR. KELLY WHITENACK |
| NPI Number: | 1134563265 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.P.M. |
| License Number: | 006669 |
| Business Practice Address: | 925 Hempstead Tpke Ste 110 Franklin Square, NY - 110103641 |
| Business Phone Number: | 5163524454 |
| Business Fax Number: | |
| Mailing Address: | 102 Willow Ave, HUNTINGTON |
| State: | NY |
| Postal Code: | 117434206 |
| Phone Number: | 5704603340 |
| Fax Number: | |
| NPI Enumeration Date: | 04/19/2013 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 006669 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |