Provider Demographics
NPI:1508656372
Name:CARLYLE, WHITTNEY
Entity type:Individual
Prefix:
First Name:WHITTNEY
Middle Name:
Last Name:CARLYLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 RUSTIC TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:NC
Mailing Address - Zip Code:28386-6211
Mailing Address - Country:US
Mailing Address - Phone:910-360-4166
Mailing Address - Fax:
Practice Address - Street 1:71 RUSTIC TRAIL RD
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:NC
Practice Address - Zip Code:28386-6211
Practice Address - Country:US
Practice Address - Phone:910-360-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist