Provider Demographics
NPI:1902076011
Name:WHITFIELD, ADRIENNE NICOLE (APRN, CFNP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:APRN, CFNP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:NICOLE
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1018 SIXTH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3837
Mailing Address - Country:US
Mailing Address - Phone:601-799-4044
Mailing Address - Fax:601-799-4045
Practice Address - Street 1:1018 SIXTH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3837
Practice Address - Country:US
Practice Address - Phone:601-799-4044
Practice Address - Fax:601-799-4045
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26090363LF0000X
MSR868356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07859339Medicaid
MSP00809714OtherRRMCARE THRU HCCN
MS302I507854Medicare PIN
MS302I507817Medicare PIN