Provider Demographics
NPI:1609822329
Name:WHITEHEAD, DEBORAH JEAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:208 COUNTY ROAD 3321
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-7809
Mailing Address - Country:US
Mailing Address - Phone:662-416-0345
Mailing Address - Fax:
Practice Address - Street 1:208 COUNTY ROAD 3321
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-7809
Practice Address - Country:US
Practice Address - Phone:662-416-0345
Practice Address - Fax:337-593-1828
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMSR59025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114766Medicaid
MS00114766Medicaid
MSPO5537Medicare UPIN
MS1609822329Medicare UPIN