Provider Demographics
NPI:1699544999
Name:WHITTEN, MICKI LOUISE (CNA)
Entity type:Individual
Prefix:
First Name:MICKI
Middle Name:LOUISE
Last Name:WHITTEN
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 1:6228 WALNUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-6161
Mailing Address - Country:US
Mailing Address - Phone:828-774-6105
Mailing Address - Fax:
Practice Address - Street 1:6228 WALNUT CREEK RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6161
Practice Address - Country:US
Practice Address - Phone:828-774-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC458380376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide