Healthcare Provider Details

I. General information

NPI: 1861881419
Provider Name (Legal Business Name): SHAWRIKA TIBBS-WHITE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 BONNY OAKS DR
CHATTANOOGA TN
37416-3538
US

IV. Provider business mailing address

6315 BONNY OAKS DR
CHATTANOOGA TN
37416-3538
US

V. Phone/Fax

Practice location:
  • Phone: 423-208-0394
  • Fax:
Mailing address:
  • Phone: 423-208-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number057606
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: