Individual provider Active NPI

Ann Nicole Whitson, CNP

  • Family Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1508029695
Registry record updated Jul 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
813912 Issued in MS
Practice address
4209 Lincoln Road
Hattiesburg, MS 39402
Phone
(601) 579-5400
Fax
(601) 261-3521
NPI assigned
Jul 8, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R813912 MS
Family Nurse Practitioner 363LF0000X 813912 MS Primary

Addresses

Primary practice location

4209 Lincoln Road
Hattiesburg, MS 39402

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 288-8004

Other identifiers 3

IdentifierTypeStateIssuer
9993647OtherMSAETNA
2954023OtherMSUHC
02750798MedicaidMS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nwhitson3830@directpatientrecord.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090302000483 MS Practitioner - Nurse Practitioner 1759447691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

415 S 28TH Ave
Hattiesburg Clinic Department of Surgery
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
813912MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic, PA CurrentSince Mar 1, 2011 Accepting new patients
Hattiesburg Clinic PA CurrentSince Mar 1, 2011 Accepting new patients
Hattiesburg Clinic, PA Past Accepting new patients
Forrest County General Hospital Past Accepting new patients

Locations

4209 Lincoln Rd
Hattiesburg, MS 39402
Phone (601) 579-5400

1 Lincoln Pkwy
Ste 302
Hattiesburg, MS 39402
Phone (601) 268-5620

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

Interoperability endpoints

  • Direct secure messaging: nwhitson3830@directpatientrecord.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1508029695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-288-8004",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4209 LINCOLN ROAD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39402",
            "telephone_number": "601-579-5400",
            "fax_number": "601-261-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITSON",
        "first_name": "ANN",
        "middle_name": "NICOLE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R813912",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "813912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9993647",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2954023",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02750798",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nwhitson3830@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4209 Lincoln Road",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "39402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.