Provider Demographics
NPI:1508029695
Name:WHITSON, ANN NICOLE (CNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:NICOLE
Last Name:WHITSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-288-8004
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:4209 LINCOLN ROAD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-579-5400
Practice Address - Fax:601-261-3521
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR813912363L00000X
MS813912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9993647OtherAETNA
MS2954023OtherUHC
MS02750798Medicaid
MS02750798Medicaid