Provider Demographics
NPI:1558369116
Name:WHITE, CAROL L (APRN, BC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300B E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2734
Mailing Address - Country:US
Mailing Address - Phone:423-702-7900
Mailing Address - Fax:423-702-7905
Practice Address - Street 1:251 N LYERLY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2728
Practice Address - Country:US
Practice Address - Phone:423-826-8000
Practice Address - Fax:423-826-8005
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN08333363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386460Medicaid
TN3386460Medicaid