1629346481 NPI number — MRS. CARLISHA MARIE WHITLOW DNP

Table of content: MRS. CARLISHA MARIE WHITLOW DNP (NPI 1629346481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629346481 NPI number — MRS. CARLISHA MARIE WHITLOW DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLOW
Provider First Name:
CARLISHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLMES
Provider Other First Name:
CARLISHA
Provider Other Middle Name:
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:
1629346481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8110 N BROTHER BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLETT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38133-2760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-255-5221
Provider Business Mailing Address Fax Number:
901-373-4511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
681 S WHITE STATION RD STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-4563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-276-3222
Provider Business Practice Location Address Fax Number:
901-276-1398
Provider Enumeration Date:
12/08/2011

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: 363LF0000X , with the licence number:  0000016237 , 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)