Healthcare Provider Details

I. General information

NPI: 1740992478
Provider Name (Legal Business Name): DOROTHY TAZEWELL WHITENER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 N CROATAN HWY
KILL DEVIL HILLS NC
27849
US

IV. Provider business mailing address

5121 N CROATAN HWY
KITTY HAWK NC
27949-3989
US

V. Phone/Fax

Practice location:
  • Phone: 252-256-0168
  • Fax:
Mailing address:
  • Phone: 252-256-0168
  • Fax: 844-328-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017341
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: