Provider Demographics
NPI:1437611480
Name:HOLLIFIELD, WHITNEY DEEANNE (APN)
Entity type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:DEEANNE
Last Name:HOLLIFIELD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-5742
Mailing Address - Fax:423-723-2669
Practice Address - Street 1:444 CLINCHFIELD ST STE 202
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3863
Practice Address - Country:US
Practice Address - Phone:423-723-2850
Practice Address - Fax:423-723-2851
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN194330163W00000X
TNAPN25809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ049119Medicaid