Provider Demographics
NPI:1750833232
Name:WHITEHEAD, CARRIE LEIGH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEIGH
Last Name:WHITEHEAD
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 1:6228 BRADLEY PARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3605
Mailing Address - Country:US
Mailing Address - Phone:706-322-1486
Mailing Address - Fax:706-324-3419
Practice Address - Street 1:6228 BRADLEY PARK DR. SUITE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-617-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 169401363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health