Provider Demographics
NPI:1336185479
Name:WHITWORTH, PAMELA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4155
Mailing Address - Country:US
Mailing Address - Phone:865-207-4418
Mailing Address - Fax:865-212-3703
Practice Address - Street 1:101 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4155
Practice Address - Country:US
Practice Address - Phone:865-207-4418
Practice Address - Fax:865-212-3703
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3029841OtherBCBS OF TN
TN3688364Medicaid
TN3688364Medicare ID - Type Unspecified