MEDICARE: RYLEE ELIZABETH WHITTAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1801755665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLEE ELIZABETH WHITTAKER

Provider Business Mailing Address
First Line	:	1465 LOCKERTSVILLE RD
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-4814
Country	:	US
Telephone Number	:	615-979-7486
Fax Number	:

Provider Business Practice Location Address
First Line	:	979 E 3RD ST STE C520
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2137
Country	:	US
Telephone Number	:	423-778-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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