Provider Demographics
NPI:1417756628
Name:WHITFIELD, HENRY TRE'SHAUN
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:TRE'SHAUN
Last Name:WHITFIELD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HICKORY HEIGHTS DR APT 3104
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4659
Mailing Address - Country:US
Mailing Address - Phone:217-918-9468
Mailing Address - Fax:
Practice Address - Street 1:169 HICKORY HEIGHTS DR APT 3104
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4659
Practice Address - Country:US
Practice Address - Phone:217-918-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program