Healthcare Provider Details

I. General information

NPI: 1053319863
Provider Name (Legal Business Name): TERRY LEE WHYTE JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TERRY LEE WHYTE JR. FNP-C

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S LINDEN RD
FLINT MI
48532-9800
US

IV. Provider business mailing address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax: 248-620-6402
Mailing address:
  • Phone: 800-395-3223
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704209317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: