Healthcare Provider Details

I. General information

NPI: 1699574137
Provider Name (Legal Business Name): CAROLINE WHALEY DAVIDENKO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3789 COVINGTON PIKE
MEMPHIS TN
38135-2279
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-372-3200
  • Fax: 901-388-9501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38349
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: