Basic Information
| Provider Information | |||||||||
| NPI: | 1124763768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITEHURST | ||||||||
| FirstName: | K'SHYLAH | ||||||||
| MiddleName: | SHEBREEYCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 BOOKER CREEK RD APT 11C | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275145103 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 MACNIDER HALL CB# 7220 333 SOUTH COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2022 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.