Provider Demographics
NPI:1285741884
Name:WHITEHURST, ANGIE MICHELLE (CFNP)
Entity type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:MICHELLE
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-1936
Mailing Address - Country:US
Mailing Address - Phone:662-423-5007
Mailing Address - Fax:662-423-5050
Practice Address - Street 1:109 E QUITMAN ST
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1936
Practice Address - Country:US
Practice Address - Phone:662-423-5007
Practice Address - Fax:662-423-5007
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07837508Medicaid
35824OtherTLC
MSR851652OtherMS. BOARD OF NURSING
MSMW1946233OtherDEA
35824OtherTLC