Provider Demographics
NPI:1902212913
Name:WHITENER, BETHANY (FNP-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:WHITENER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-1175
Mailing Address - Country:US
Mailing Address - Phone:423-548-1000
Mailing Address - Fax:423-548-1002
Practice Address - Street 1:104 GRAND AVE
Practice Address - Street 2:
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317
Practice Address - Country:US
Practice Address - Phone:423-548-1000
Practice Address - Fax:423-548-1002
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily