Provider Demographics
NPI:1265059851
Name:WIHITE, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:WIHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6574 E BRAINERD RD APT 920
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3710
Mailing Address - Country:US
Mailing Address - Phone:901-584-6654
Mailing Address - Fax:
Practice Address - Street 1:6574 E BRAINERD RD APT 920
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3710
Practice Address - Country:US
Practice Address - Phone:901-584-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program