1316242829 NPI number — MS. WHITNEY MOORE PETTIT SPEECH THERAPIST

Table of content: MS. WHITNEY MOORE PETTIT SPEECH THERAPIST (NPI 1316242829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316242829 NPI number — MS. WHITNEY MOORE PETTIT SPEECH THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETTIT
Provider First Name:
WHITNEY
Provider Middle Name:
MOORE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SPEECH THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316242829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23996
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39225-3996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-206-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 PARKWAY PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOSCIUSKO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39090-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-289-3588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  S3248 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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