Healthcare Provider Details

I. General information

NPI: 1669933669
Provider Name (Legal Business Name): STEPHANIE LYNN WHITMIRE AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

IV. Provider business mailing address

2007 HIGHWAY 82
ETHELSVILLE AL
35461-3097
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1012
  • Fax: 662-328-1507
Mailing address:
  • Phone: 662-386-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR872661
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906649
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: