Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R877381 | MS |
NPI | 1003107194 |
---|---|
Provider Name | Ms. Karen Marie Whitney |
First Address | Whitfield, MS 39193-0157 |
Second Address | Whitfield, MS 39193-0157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |