Provider Demographics
NPI:1629346481
Name:WHITLOW, CARLISHA MARIE (DNP)
Entity Type:Individual
Prefix:MRS
First Name:CARLISHA
Middle Name:MARIE
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CARLISHA
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8110 N BROTHER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2760
Mailing Address - Country:US
Mailing Address - Phone:901-255-5221
Mailing Address - Fax:901-373-4511
Practice Address - Street 1:681 S WHITE STATION RD STE 111
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4563
Practice Address - Country:US
Practice Address - Phone:901-276-3222
Practice Address - Fax:901-276-1398
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000016237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I507461Medicare PIN