Individual
LESA COLLEEN WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
434 N CAPTAIN GLOSTER DR, GLOSTER, MS 39638-3401
(601) 225-4711
(601) 225-7861
Mailing address
PO BOX 639, CENTREVILLE, MS 39631-0639
(601) 645-5221
(601) 645-5842
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R853722
MS
Other
Enumeration date
01/27/2012
Last updated
01/27/2012
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