Healthcare Provider Details

I. General information

NPI: 1235074618
Provider Name (Legal Business Name): WHIGHAM LEGACY TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 DOVER RD
ROCKY MOUNT NC
27804-2506
US

IV. Provider business mailing address

PO BOX 415
ROCKY MOUNT NC
27802-0415
US

V. Phone/Fax

Practice location:
  • Phone: 757-403-1383
  • Fax:
Mailing address:
  • Phone: 757-403-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER WHIGHAM SR.
Title or Position: CEO
Credential: MHT
Phone: 757-403-1383