Basic Information
| Provider Information | |||||||||
| NPI: | 1720796022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIXSON | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | WYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 SHALLOWFORD RD STE 109 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238939335 | ||||||||
| FaxNumber: | 4238939336 | ||||||||
| Practice Location | |||||||||
| Address1: | 5959 SHALLOWFORD RD STE 109 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238939335 | ||||||||
| FaxNumber: | 4238939336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 034282 | TN | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
ID Information
| ID | Type | State | Issuer | Description | 034282 | 01 | TN | TENNESSEE BOARD OF PHARMACY | OTHER |