Active NPI
Patricia Weathersby, MD
- Specialist
- Greenwood, MS
National Provider Identifier
1013905272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 08062
- Practice address
- 202 W Park Ave
Greenwood, MS 38930-3009 - Phone
- (662) 453-0646
- Fax
- (662) 455-6842
- NPI assigned
- Oct 12, 2005
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 08062 | MS | Primary |
Addresses
Primary practice location
202 W Park Ave
Greenwood, MS 38930-3009
Mailing address
202 W Park Ave
Greenwood, MS 38930-3009
Phone (662) 453-0646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00122953 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08062 | MS | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013905272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 W PARK AVE",
"city": "GREENWOOD",
"state": "MS",
"postal_code": "389303009",
"telephone_number": "662-453-0646",
"fax_number": "662-455-6842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 W PARK AVE",
"city": "GREENWOOD",
"state": "MS",
"postal_code": "389303009",
"telephone_number": "662-453-0646",
"fax_number": "662-455-6842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEATHERSBY",
"first_name": "PATRICIA",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MS",
"license": "08062",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00122953",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.