Individual
WHITNEY BROOKE TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
391 SERPENTINE DR STE 250, SPARTANBURG, SC 29303
(864) 560-6717
(864) 560-7105
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2955
TN
363A00000X
Physician Assistant
Primary
TL3012
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3675PA
—
SC
01
—
5542034
BCBS OF TN
TN
05
—
Q020109
—
TN
01
—
SCD2697628
MEDICARE PIN
SC
Enumeration date
02/12/2016
Last updated
12/31/2020
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