Provider Demographics
NPI:1871611285
Name:WHITEHEAD, CAROLYN VICTORIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:VICTORIA
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:VICTORIA
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:255 E WATT ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2236
Practice Address - Country:US
Practice Address - Phone:865-273-1616
Practice Address - Fax:865-273-1645
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TNRN171356163W00000X
TNAPN22413363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse