Healthcare Provider Details

I. General information

NPI: 1942437595
Provider Name (Legal Business Name): WHITNEY HERRON NESBIT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 BOLING ST
JACKSON MS
39213-4418
US

IV. Provider business mailing address

1635 BOLING ST
JACKSON MS
39213-4418
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-0123
  • Fax: 601-366-0649
Mailing address:
  • Phone: 601-366-0123
  • Fax: 601-366-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1544
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: