Diane Louise Whitehead, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PHD 425 Issued in TN

Practice address

607 Baxter St
Fairview Ass.
Johnson City, TN 37601

Phone

(423) 232-2670

Fax

(423) 928-0381

NPI assigned

Aug 31, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396857322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 BAXTER ST",
            "address_2": "FAIRVIEW ASS.",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-232-2670",
            "fax_number": "423-928-0381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "DIANE",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "PHD 425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROF TRIGON",
            "identifier": "119750",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3980891",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PINNACLE",
            "identifier": "0106607",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PREFTRIGON",
            "identifier": "119750",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7692240",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3689293",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN SUMMIT",
            "identifier": "0106607",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS (GROUP)",
            "identifier": "334969",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN NAVIGATOR",
            "identifier": "0106607",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela J White, PT
• Sherri Gayle White, NP
• Ted Allan White, ANP-BC
• Vickie Annette White, PT
• Christal Sheets Whitehead, FNP-BC
• Jennifer Lyn Whitehead, LCSW
• Savanna M Whitehead, NP
• Benjamin Daniel Whitfield, D.O. M.S.W.
• Breanna Whitfield, NP
• Jean P Whitinger, LMFT

• Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.