Basic Information
| Provider Information | |||||||||
| NPI: | 1093729139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAULDIN | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | ROOP | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D,FAAA,CCC-A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROOP | ||||||||
| OtherFirstName: | WHITNEY | ||||||||
| OtherMiddleName: | HEATHER | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A.,FAAA,CCC-A | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9724 KINGSTON PIKE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656949870 | ||||||||
| FaxNumber: | 8656949871 | ||||||||
| Practice Location | |||||||||
| Address1: | 9724 KINGSTON PIKE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656949870 | ||||||||
| FaxNumber: | 8656949871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 1197 | TN | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | 3590 | GA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 1197 | TN | Y | Speech, Language and Hearing Service Providers | Audiologist | 231HA2500X | 1197 | TN | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier |
ID Information
| ID | Type | State | Issuer | Description | 31920111 | 01 | TN | MEDICARE NPI | OTHER | 4640001 | 01 | TN | UNITED HEALTH CARE | OTHER | 3148987 | 01 | TN | BLUECROSSBLUE SHIELD | OTHER | 4171594 | 01 | TN | BCBS | OTHER | 1504820 | 05 | TN | MEDICAID | 3148987 | 05 | TN | MEDICAID |