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NPI Code Detail

MEDICARE: DR. PHYLLIS BROWN WHITEHEAD PHD, CNS, ACHPN

MEDICARE: DR. PHYLLIS BROWN WHITEHEAD PHD, CNS, ACHPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364S00000XClinical Nurse Specialist0024182030VA

General Provider Information

NPI Number : 1124451679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHYLLIS BROWN WHITEHEAD PHD, CNS, ACHPN
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number : 540-224-5516
Fax Number :
Provider Business Practice Location Address
First Line : 1906 BELLEVIEW AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1838
Country : US
Telephone Number : 540-981-7000
Fax Number : 540-985-5377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2013
Last Update Date : 05/19/2026

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