Provider Demographics
NPI:1477627016
Name:WHITMORE, JOHNENNE EVETTE (DNSC, APRN, FNP, BC)
Entity type:Individual
Prefix:DR
First Name:JOHNENNE
Middle Name:EVETTE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:DNSC, APRN, FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 LIDA LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-1021
Mailing Address - Country:US
Mailing Address - Phone:901-745-7779
Mailing Address - Fax:901-745-7347
Practice Address - Street 1:11437 MILTON WILSON ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002
Practice Address - Country:US
Practice Address - Phone:901-745-7779
Practice Address - Fax:901-745-7347
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000069180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP87173Medicare UPIN