SHANE LEE WHITESIDE (NPI# 1174174502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174174502 |
| Entity Type | Individual |
| Full Name | SHANE LEE WHITESIDE |
| Practice Address |
152 Highway 7 S Oxford MS 38655-5392 |
| Mailing Address |
5280 County Road 220 Water Valley MS 38965-6221 |
| Practice Telephone | 6622347521 |
| Practice Fax Number | 6622363071 |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2019-09-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
152 HIGHWAY 7 S |
| City | OXFORD |
| State | MS |
| Zip Code | 38655-5392 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649374265 | Mary Sue Speck | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2006-09-12 |
| 1396346565 | Macy Lillian Newcomb | Social Worker | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-11-04 |
| 1760082580 | Kimberly Eve Spence | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-10-30 |
| 1932707999 | Tanya Evans | Registered Nurse | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-10-13 |
| 1578179545 | Tiffany Nail | Registered Nurse | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-09-16 |
| 1255947248 | Macarah Morris | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-09-16 |
| 1073128641 | Adole Natasha Muruako | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-09-10 |
| 1174137673 | Kristen Lindsey Cauley | Social Worker | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-09-02 |
| 1447863741 | Elizabeth Danielle Cornelius | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-08-26 |
| 1316550759 | Angel Simmons | Counselor | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-08-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619585809 | Oxford Treatment Center, LLC | Substance Abuse Rehabilitation Facility | 616 Commerce Parkway, Oxford, MS 38655 | 2020-07-14 |
| 1760044465 | Lindsay Low Beauchamp | Speech-Language Pathologist | 169 Ms-6 #102, Oxford, MS 38655 | 2019-07-02 |
| 1861058075 | Tomiko D Mackey | Social Worker | 100 Carriage Cove, Oxford, MS 38655 | 2019-05-13 |
| 1174090039 | Derionne Brooks | Specialist/Technologist | 972 Hathorn Road, University, MS 38655 | 2018-10-30 |
| 1497236327 | Providence Companion Care | Nurse's Aide | 317 Heritage Dr Ste 3b, Oxford, MS 38655 | 2018-08-28 |
| 1255817292 | Marcela Caroline Weber | Counselor | 152 Mississippi 7 South, Oxford, MS 38655 | 2018-07-12 |
| 1649775123 | Oxford Outpatient Center, LLC | Clinic/Center | 611 Commerce Pkwy, Oxford, MS 38655 | 2018-03-27 |
| 1073039962 | Sharon Yvette Holloway | Social Worker | 152 Hwy and South, Oxford, Ms 38655, Oxford, MS 38655 | 2017-08-22 |
| 1447774682 | Courtney M Purvis | Physical Therapist | 300 Enterprise Dr Ste B, Oxford, MS 38655 | 2017-07-31 |
| 1649716580 | Taylor Lynn Smith | Counselor | 152 Ms-7, Oxford, MS 38655 | 2017-01-17 |
| Find all providers in zip 38655 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768680 | Matthew Milz | Peer Specialist | 145o S Lapeer Rd, Oxford, MI 48371-4982 | 2020-04-07 |
| 1760082580 | Kimberly Eve Spence | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-10-30 |
| 1962031468 | Frank Pace | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-04-06 |
| 1982230058 | Hannah Jade Mixon | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-03-20 |
| 1700417110 | Jennifer Nicole Zaha | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2020-02-04 |
| 1942847652 | Suzanne Shepherd | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2019-12-02 |
| 1730720012 | Dixie Carol Thetford | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2019-10-08 |
| 1336790674 | Joshua M Walston | Peer Specialist | 152 Highway 7 S, Oxford, MS 38655-5392 | 2019-09-27 |
| 1568011195 | Kathryn Burman | Peer Specialist | 1450 S Lapeer Rd, Oxford, MI 48371-6108 | 2019-09-06 |
| 1922652999 | Shanith Nicole Tedford | Peer Specialist | 152a Highway 7 S, Oxford, MS 38655-5392 | 2019-07-29 |
| Find all providers in OXFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.