Provider Demographics
NPI:1811511819
Name:NORTHINGTON, ARETHA M (PMHNP)
Entity type:Individual
Prefix:
First Name:ARETHA
Middle Name:M
Last Name:NORTHINGTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ARETHA
Other - Middle Name:MARCELLA
Other - Last Name:NORTHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1430 WINGFIELD DR.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4448
Mailing Address - Country:US
Mailing Address - Phone:601-519-9822
Mailing Address - Fax:
Practice Address - Street 1:64 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8382
Practice Address - Country:US
Practice Address - Phone:601-909-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904621363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty