Provider Demographics
NPI:1720185754
Name:LANEHART, JENNIFER WHETSTONE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WHETSTONE
Last Name:LANEHART
Suffix:
Gender:F
Credentials:NP
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 74
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39669-0074
Mailing Address - Country:US
Mailing Address - Phone:601-888-6181
Mailing Address - Fax:601-888-3685
Practice Address - Street 1:451 BANK ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:MS
Practice Address - Zip Code:39669-6000
Practice Address - Country:US
Practice Address - Phone:601-888-3421
Practice Address - Fax:601-888-3685
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07184351Medicaid
LA1889181Medicaid
LA1889181Medicaid
MS500001174Medicare ID - Type Unspecified