Provider Demographics
NPI:1639286941
Name:WHEELESS, EVA S (FNP)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:S
Last Name:WHEELESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:LEAKESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39451
Mailing Address - Country:US
Mailing Address - Phone:601-394-2381
Mailing Address - Fax:601-394-2593
Practice Address - Street 1:1616 WILLIAMS DRIVE
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451
Practice Address - Country:US
Practice Address - Phone:601-394-2381
Practice Address - Fax:601-394-2593
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR564249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112015Medicaid
MS500000944Medicare ID - Type Unspecified
MS00112015Medicaid