Provider Demographics
NPI:1316537053
Name:WHITBY, JEFFREY HAYDEN (APRN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HAYDEN
Last Name:WHITBY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 FEATHERSTONE CV
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-6928
Mailing Address - Country:US
Mailing Address - Phone:731-431-1504
Mailing Address - Fax:
Practice Address - Street 1:2017 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3934
Practice Address - Country:US
Practice Address - Phone:731-222-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner