=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275007510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRI JO WHITTINGTON PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2019
-----------------------------------------------------
Last Update Date | 04/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12183 MS HIGHWAY 182 STE 108
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39759-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-268-7100
-----------------------------------------------------
Fax | 662-268-6080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12183 MS HIGHWAY 182 STE 108
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39759-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-268-7100
-----------------------------------------------------
Fax | 662-268-6080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 904366
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------