Provider Demographics
NPI:1275636086
Name:WHITEHURST, JAMA C (RD)
Entity Type:Individual
Prefix:
First Name:JAMA
Middle Name:C
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N WINSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8467
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-937-0445
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0200
Practice Address - Fax:252-937-0445
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001899133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC710000727OtherRAILROAD MEDICARE
NC2991285AMedicare PIN