Provider Demographics
NPI:1154672368
Name:WHITEHEAD, RHONDA SUE (CNA)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 OLD RAILROAD GRADE RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687-3810
Mailing Address - Country:US
Mailing Address - Phone:423-213-3465
Mailing Address - Fax:
Practice Address - Street 1:974 OLD RAILROAD GRADE RD
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3810
Practice Address - Country:US
Practice Address - Phone:423-213-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00049382172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker