Healthcare Provider Details

I. General information

NPI: 1780967596
Provider Name (Legal Business Name): WHITNEY JOHNSON CARROLL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY JOHNSON FNP-BC

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60021 MONROE ST
SMITHVILLE MS
38870-7779
US

IV. Provider business mailing address

PO BOX 305
SMITHVILLE MS
38870-0305
US

V. Phone/Fax

Practice location:
  • Phone: 662-651-4637
  • Fax: 662-651-4636
Mailing address:
  • Phone: 662-651-4637
  • Fax: 662-651-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR876898
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: