Organization
WHITEHEAD WOUND CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESA COLLEEN WHITEHEAD NP-C (NP-C)
(601) 395-2585
Entity
Organization
Contact information
Practice address
427 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2350
(601) 835-9444
Mailing address
PO BOX 756, CENTREVILLE, MS 39631-0756
(601) 395-2585
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R853722
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06475799
—
MS
Enumeration date
07/31/2018
Last updated
07/31/2018
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