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General NPI Number Information
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NPI Number | 1508310012
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Entity Type | Organization
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Legal Business Name | WHITLEY MEDICAL SERVICE INC
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 143 VETERANS PKWY
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City | MURFREESBORO
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State | TN
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Zip | 37128-6434
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Country | US
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Telephone | 615-904-6033
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 CARBON COPY CT
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City | MURFREESBORO
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State | TN
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Zip | 37130-6689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CANDACE WHITLEY
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Credential | PA-C
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Telephone | 615-306-8849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1195
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License Number State | TN
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