Healthcare Provider Details

I. General information

NPI: 1063383438
Provider Name (Legal Business Name): AMBER NICOLE WHITEHORN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5903 RIDGEWOOD RD
JACKSON MS
39211-3700
US

IV. Provider business mailing address

142 W LEGACY DR
BRANDON MS
39042-5518
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4820
  • Fax:
Mailing address:
  • Phone: 662-528-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907593
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: