Provider Demographics
NPI:1740866300
Name:WHITE, CARRIE KING (NP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:KING
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 WINTER GAP RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-1504
Mailing Address - Country:US
Mailing Address - Phone:865-435-3918
Mailing Address - Fax:
Practice Address - Street 1:1030 WINTER GAP RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-1504
Practice Address - Country:US
Practice Address - Phone:865-435-3918
Practice Address - Fax:865-435-3920
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine