Healthcare Provider Details

I. General information

NPI: 1265905780
Provider Name (Legal Business Name): SHAKIERA MONIQUE WHYTE HENRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 RUIN CREEK RD
HENDERSON NC
27536-2927
US

IV. Provider business mailing address

8117 PRESTON RD STE 800
DALLAS TX
75225-6328
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-4143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011341
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: