Provider Demographics
NPI:1710052469
Name:WHITLEY, ALICE (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 RABBIT TAIL LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8375
Mailing Address - Country:US
Mailing Address - Phone:901-874-4379
Mailing Address - Fax:901-874-2054
Practice Address - Street 1:N151 PHYSICAL READINESS PROGRAMS OPNAV
Practice Address - Street 2:5720 INTEGRITY DR.
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38055-0001
Practice Address - Country:US
Practice Address - Phone:901-874-4379
Practice Address - Fax:901-874-2054
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered