Provider Demographics
NPI:1306395264
Name:WHITE, BETHANY III (AGNP-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:WHITE
Suffix:III
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 E WEISGARBER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2674
Mailing Address - Country:US
Mailing Address - Phone:865-579-0552
Mailing Address - Fax:865-579-1154
Practice Address - Street 1:1128 E WEISGARBER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2674
Practice Address - Country:US
Practice Address - Phone:865-579-0552
Practice Address - Fax:865-579-1154
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21750363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology