Provider Demographics
NPI:1053319863
Name:WHYTE, TERRY LEE JR (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:WHYTE
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:WHYTE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6549 TOWN CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:800-395-3223
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:2401 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-9800
Practice Address - Country:US
Practice Address - Phone:800-395-3223
Practice Address - Fax:248-620-6402
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704209317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4643653Medicaid
MI5008703780OtherBCBS
MION79010003Medicare PIN