1902076011 NPI number — ADRIENNE NICOLE WHITFIELD APRN, CFNP

Table of content: ADRIENNE NICOLE WHITFIELD APRN, CFNP (NPI 1902076011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902076011 NPI number — ADRIENNE NICOLE WHITFIELD APRN, CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITFIELD
Provider First Name:
ADRIENNE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPENCE
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902076011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1018 SIXTH AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PICAYUNE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39466-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-799-4044
Provider Business Mailing Address Fax Number:
601-799-4045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 SIXTH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PICAYUNE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39466-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-799-4044
Provider Business Practice Location Address Fax Number:
601-799-4045
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  26090 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R868356 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07859339 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00809714 . This is a "RRMCARE THRU HCCN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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