MEDICARE: JESSICA WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1194146621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WHITE

Provider Business Mailing Address
First Line	:	2996 WALNUT GROVE RD
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-5358
Country	:	US
Telephone Number	:	931-722-8115
Fax Number	:

Provider Business Practice Location Address
First Line	:	2996 WALNUT GROVE RD
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-5358
Country	:	US
Telephone Number	:	931-722-8115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	12/31/2013

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Directions to “ JESSICA WHITE ” Practice Location

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