1477016103 NPI number — DENA K WHITEHOUSE NP

Table of content: DENA K WHITEHOUSE NP (NPI 1477016103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477016103 NPI number — DENA K WHITEHOUSE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITEHOUSE
Provider First Name:
DENA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENNEDY
Provider Other First Name:
DENA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477016103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37244-0426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-670-6199
Provider Business Mailing Address Fax Number:
865-670-6198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1924 ALCOA HWY # U56
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-305-9081
Provider Business Practice Location Address Fax Number:
865-305-8769
Provider Enumeration Date:
04/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  25654 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)