Provider Demographics
NPI:1699574137
Name:DAVIDENKO, CAROLINE WHALEY (FNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WHALEY
Last Name:DAVIDENKO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CARRINGTON ELM CIR E APT 201
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2813
Mailing Address - Country:US
Mailing Address - Phone:251-623-9093
Mailing Address - Fax:
Practice Address - Street 1:270 CARRINGTON ELM CIR E APT 201
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2813
Practice Address - Country:US
Practice Address - Phone:251-623-9093
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
TN38349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily