Provider Demographics
NPI:1982741310
Name:WHITBY FAMILY CLINIC
Entity Type:Organization
Organization Name:WHITBY FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITBY
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:731-855-0094
Mailing Address - Street 1:2051 S HWY 45 BYPASS
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38330
Mailing Address - Country:US
Mailing Address - Phone:731-855-0094
Mailing Address - Fax:731-855-0930
Practice Address - Street 1:2051 S HWY 45 BYPASS
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382
Practice Address - Country:US
Practice Address - Phone:731-855-0094
Practice Address - Fax:731-855-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861436446OtherINDIV NPI
TN3728972Medicaid
4030742OtherBLUE CROSS
1861436446OtherINDIV NPI
R93220Medicare UPIN