Provider Demographics
NPI:1295228005
Name:WHITE, WANDA FAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:FAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:FAY
Other - Last Name:MCGHEE-HAYNES-WHITE-SCHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:586 RUTLEDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:TN
Mailing Address - Zip Code:37709-2314
Mailing Address - Country:US
Mailing Address - Phone:865-932-6337
Mailing Address - Fax:
Practice Address - Street 1:586 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:TN
Practice Address - Zip Code:37709-2314
Practice Address - Country:US
Practice Address - Phone:865-705-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000024234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily