Healthcare Provider Details

I. General information

NPI: 1750052072
Provider Name (Legal Business Name): KRISTINA MICHELLE WHITSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA MICHELLE RODGERS

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 STARLING DR
MARYVILLE TN
37803-6910
US

IV. Provider business mailing address

3107 STARLING DR
MARYVILLE TN
37803-6910
US

V. Phone/Fax

Practice location:
  • Phone: 865-809-4556
  • Fax:
Mailing address:
  • Phone: 865-809-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number218555
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number218555
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024197389
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30472
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043150
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: