Provider Demographics
NPI:1366922205
Name:HARRISON, WHITLEY JADE (FNP-BC)
Entity type:Individual
Prefix:
First Name:WHITLEY
Middle Name:JADE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1319
Mailing Address - Country:US
Mailing Address - Phone:423-735-3405
Mailing Address - Fax:423-735-3408
Practice Address - Street 1:627 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1319
Practice Address - Country:US
Practice Address - Phone:423-735-3405
Practice Address - Fax:423-735-3408
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24618363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care