Healthcare Provider Details

I. General information

NPI: 1386258408
Provider Name (Legal Business Name): MS. CHARITY DARLENE HOHM-WHALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 COTTONWOOD DR
MIZE MS
39116-5449
US

IV. Provider business mailing address

146 COTTONWOOD DR
MIZE MS
39116-5449
US

V. Phone/Fax

Practice location:
  • Phone: 601-642-7111
  • Fax:
Mailing address:
  • Phone: 601-642-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR858724
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: