1477523959 NPI number — MRS. JONI DIANNE WHITEHEAD FNP-C

Table of content: MRS. JONI DIANNE WHITEHEAD FNP-C (NPI 1477523959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477523959 NPI number — MRS. JONI DIANNE WHITEHEAD FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITEHEAD
Provider First Name:
JONI
Provider Middle Name:
DIANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMPMAN
Provider Other First Name:
JONI
Provider Other Middle Name:
DIANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477523959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
567 WALKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRYVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70653-3040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-825-1728
Provider Business Mailing Address Fax Number:
337-825-1229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
567 WALKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRYVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70653-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-825-1728
Provider Business Practice Location Address Fax Number:
337-825-1229
Provider Enumeration Date:
01/25/2006

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: 363LF0000X , with the licence number:  78494-3569 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 673697 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP03569 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1432385 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8N8278 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00117217 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 172875001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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