Healthcare Provider Details

I. General information

NPI: 1982978607
Provider Name (Legal Business Name): KRISTEN ELIZABETH WHEELOCK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 TOMMY MUNRO DR
BILOXI MS
39532-2150
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 228-396-3167
  • Fax: 601-496-8101
Mailing address:
  • Phone: 601-815-2895
  • Fax: 601-496-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR878630
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: