Provider Demographics
NPI:1467022939
Name:MIDDLETON, WEATON M (MP-C)
Entity type:Individual
Prefix:MRS
First Name:WEATON
Middle Name:M
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S HOLLY AVE.
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-3776
Mailing Address - Country:US
Mailing Address - Phone:601-765-6711
Mailing Address - Fax:601-698-0112
Practice Address - Street 1:3275 HIGHWAY 49 STE E
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3776
Practice Address - Country:US
Practice Address - Phone:601-765-6292
Practice Address - Fax:601-698-0112
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily