Provider Demographics
NPI:1225233463
Name:WHITE HOUSE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WHITE HOUSE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-672-0604
Mailing Address - Street 1:2823 HIGHWAY 31 W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-5241
Mailing Address - Country:US
Mailing Address - Phone:615-672-0604
Mailing Address - Fax:615-672-0646
Practice Address - Street 1:2823 HIGHWAY 31 W
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-5241
Practice Address - Country:US
Practice Address - Phone:615-672-0604
Practice Address - Fax:615-672-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639104268OtherNPI
1639104268OtherNPI