Provider Demographics
NPI:1295116531
Name:WHITEHURST, DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 LEVY LN
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1562
Mailing Address - Country:US
Mailing Address - Phone:410-366-0726
Mailing Address - Fax:731-202-9026
Practice Address - Street 1:11100 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1554
Practice Address - Country:US
Practice Address - Phone:731-228-2000
Practice Address - Fax:731-202-9026
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN596822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty