Healthcare Provider Details

I. General information

NPI: 1336063221
Provider Name (Legal Business Name): DERM DIRECT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 PROSPECT CT
COLUMBIA TN
38401-3399
US

IV. Provider business mailing address

1114 PROSPECT CT
COLUMBIA TN
38401-3399
US

V. Phone/Fax

Practice location:
  • Phone: 423-377-9849
  • Fax:
Mailing address:
  • Phone: 423-377-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEENA WHITAKER
Title or Position: OWNER
Credential: NP
Phone: 423-377-9849