Individual
MRS. WHITNEY DIANE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2514 WESLEY ST STE 102, JOHNSON CITY, TN 37601-1764
(423) 282-2700
(423) 282-2802
Mailing address
2514 WESLEY ST STE 102, JOHNSON CITY, TN 37601-1764
(423) 282-2700
(423) 282-2802
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0000002497
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-00630
NC PA LICENSE INACTIVE
NC
05
—
1265594618
—
TN
Enumeration date
12/14/2006
Last updated
03/07/2023
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