Healthcare Provider Details

I. General information

NPI: 1760374912
Provider Name (Legal Business Name): NICAYAH MONE WHALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E 4TH ST
CHATTANOOGA TN
37403-1925
US

IV. Provider business mailing address

7310 STANDIFER GAP RD APT 510
CHATTANOOGA TN
37421-1467
US

V. Phone/Fax

Practice location:
  • Phone: 423-425-4706
  • Fax:
Mailing address:
  • Phone: 470-209-6504
  • Fax: 470-209-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: