Provider Demographics
NPI:1891258893
Name:WHITTEMORE, LAURA LOTT (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LOTT
Last Name:WHITTEMORE
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 1:110 TCHULA ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3111
Mailing Address - Country:US
Mailing Address - Phone:662-834-5339
Mailing Address - Fax:601-815-0456
Practice Address - Street 1:110 TCHULA ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3111
Practice Address - Country:US
Practice Address - Phone:662-834-5339
Practice Address - Fax:601-815-0456
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902753363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily