Healthcare Provider Details

I. General information

NPI: 1316319353
Provider Name (Legal Business Name): WHITNEY WHITESIDE ABRAHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

IV. Provider business mailing address

102 HOLLY HOCK LN
STARKVILLE MS
39759-2467
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1012
  • Fax: 662-328-1507
Mailing address:
  • Phone: 662-803-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901343
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: