Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brandon Lane Whitlock, AG-ACNP

Individual provider Family Nurse Practitioner · NPI 1124353719

Brandon Lane Whitlock, AG-ACNP is a Nurse Practitioner in Clarkston, Washington. Qualified in 2020, 6 years ago. Practices with Tri-State Memorial Hospital, a 34-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho and Washington.

Years since qualifying
6
Licensed in
ID, WA
In the registry since
2009
Specialties on file
2

Practice location Address checks out

1119 Highland Ave Ste 7
Clarkston, WA 99403-2836
Phone: (509) 758-1119
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 627 6th Ave, Lewiston, ID 83501-2424 — (208) 746-7784

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence AP61081911 (WA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 65287 (ID)

Record details

NPI number1124353719
Entity typeIndividual (Type 1)
GenderMale
Credentials AG-ACNP
Sole proprietorYes
NPI enumeratedOctober 15, 2009
Last updated in NPPESMay 29, 2025
Certification dateMay 29, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Tri-State Memorial Hospital — 34 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Clarkston