Provider Demographics
NPI:1124451679
Name:WHITEHEAD, PHYLLIS BROWN (PHD, CNS, ACHPN)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:BROWN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PHD, CNS, ACHPN
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-521-6048
Practice Address - Fax:540-344-3641
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2022-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0015000746364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist