Provider Demographics
NPI:1578995791
Name:ERICKSON, WHITNEY BOLTON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:BOLTON
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 MACON TER STE 103
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8505
Mailing Address - Country:US
Mailing Address - Phone:901-757-0568
Mailing Address - Fax:
Practice Address - Street 1:8316 MACON TER STE 103
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8505
Practice Address - Country:US
Practice Address - Phone:901-757-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17813363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health