Provider Demographics
NPI:1336669258
Name:PETERSON, WHITNEY J (PA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:J
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARSHALL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1687
Mailing Address - Country:US
Mailing Address - Phone:601-353-9900
Mailing Address - Fax:601-353-3654
Practice Address - Street 1:501 MARSHALL ST STE 301
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1687
Practice Address - Country:US
Practice Address - Phone:601-353-9900
Practice Address - Fax:601-353-3654
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant