Provider Demographics
NPI:1760028294
Name:LEE, ERIN WHITLEY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:WHITLEY
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-8587
Mailing Address - Country:US
Mailing Address - Phone:662-549-6286
Mailing Address - Fax:
Practice Address - Street 1:171 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MS
Practice Address - Zip Code:39740-8587
Practice Address - Country:US
Practice Address - Phone:662-855-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907023163W00000X
MS905018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse