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1255094835 NPI number — BRE'ANNA WHIGHAM

NPI Number: 1255094835
Health Care Provider/Practitioner: BRE'ANNA WHIGHAM

Information about “1255094835” NPI (BRE'ANNA WHIGHAM) exists in 1255094835 in HTML format HTML  |  1255094835 in plain Text format TXT  |  1255094835 in PDF (Portable Document Format) PDF  |  1255094835 in an XML format XML  formats.

NPI Number : 1255094835 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255094835",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WHIGHAM",
    "FirstName": "BRE'ANNA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1867 CRANE RIDGE DR STE 150C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSON",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39216-4982",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "769-251-5550",
    "MailingAddressFaxNumber": "769-251-5590",
    "FirstLinePracticeLocationAddress": "11 WOODSTONE PLZ",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HATTIESBURG",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39402-8342",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "769-390-7234",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/20/2021",
    "LastUpdateDate": "10/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": "21-189522",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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