Provider Demographics
NPI:1407410947
Name:WHITEHEAD, LYNN NEVELS (NP-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:NEVELS
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 S KING RD
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-3209
Mailing Address - Country:US
Mailing Address - Phone:256-616-3681
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3929
Practice Address - Country:US
Practice Address - Phone:662-247-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903131363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner