Provider Demographics
NPI:1114475209
Name:FORD, WHITNEY BROOKS (NP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BROOKS
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SECURITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3626
Mailing Address - Country:US
Mailing Address - Phone:731-664-9040
Mailing Address - Fax:731-664-9041
Practice Address - Street 1:200 RIVERHILLS BUSINESS PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-995-0899
Practice Address - Fax:205-995-0451
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21928363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL214174Medicaid
AL214963Medicaid