Provider Demographics
NPI:1386218923
Name:WHITEHEAD, MEGHAN LEIGH (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LEIGH
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 E 3RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2161
Mailing Address - Country:US
Mailing Address - Phone:423-624-4846
Mailing Address - Fax:
Practice Address - Street 1:1042 E 3RD ST STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2161
Practice Address - Country:US
Practice Address - Phone:423-624-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000028687363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics