Provider Demographics
NPI:1932449907
Name:ROSS, WHITNEY LITITIA (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LITITIA
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 DAYTON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373-7823
Mailing Address - Country:US
Mailing Address - Phone:423-498-3560
Mailing Address - Fax:423-498-3563
Practice Address - Street 1:14402 DAYTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373-7823
Practice Address - Country:US
Practice Address - Phone:423-498-3560
Practice Address - Fax:423-498-3563
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532076Medicaid