Provider Demographics
NPI:1831149947
Name:WHITFIELD, CARLA (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:WHITFIELD
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:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:598 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:MS
Practice Address - Zip Code:39455-2350
Practice Address - Country:US
Practice Address - Phone:601-545-8700
Practice Address - Fax:601-582-5461
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR714232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS29391 SOtherHUMANA/TRICARE
MS00201796Medicaid
MS8208387P01OtherCIGNA
MS1144085OtherWINDSOR HEALTH GROUP
MS7484916OtherAETNA
MSP00726914OtherRAILROAD MEDICARE
MS8208387P01OtherCIGNA
MS00201796Medicaid