MEDICARE: CHARITY LENEE WHITEHEAD RN BSN

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
1	163WH0200X	Home Health Registered Nurse	935414	TX
2	163W00000X	Registered Nurse	935414	TX
3	163WC1500X	Community Health Registered Nurse	935414	TX

General Provider Information

NPI Number	:	1174201180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY LENEE WHITEHEAD RN BSN

Provider Business Mailing Address
First Line	:	6616 DOVE CHASE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1693
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6616 DOVE CHASE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1693
Country	:	US
Telephone Number	:	682-359-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	01/29/2026

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