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Individual
TINA WHITEHEAD
Active
Individual
TINA WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3007764
KY
363LF0000X
Family Nurse Practitioner
Primary
3007764
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000812693
ANTHEM - HYDEN
KY
01
—
000000813017
ANTHEM - HAZARD
KY
05
—
7100252530
—
KY
Enumeration date
11/16/2012
Last updated
10/03/2013
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