Provider Demographics
NPI:1154351815
Name:WOOLBRIGHT, THERESA P (FNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:P
Last Name:WOOLBRIGHT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LINCOLN PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3261
Mailing Address - Country:US
Mailing Address - Phone:601-288-8050
Mailing Address - Fax:
Practice Address - Street 1:1 LINCOLN PKWY STE 202
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3261
Practice Address - Country:US
Practice Address - Phone:601-288-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR541265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500011980OtherMEDICARE RAILROAD
MS06606224Medicaid
MS500000627Medicare ID - Type Unspecified
MSR56841Medicare UPIN