MEDICARE: LAURA H WHITE PMHNP, FNP-C

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	363LF0000X	Family Nurse Practitioner	RN118676	GA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN118676	GA

General Provider Information

NPI Number	:	1265883730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA H WHITE PMHNP, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 394
Second Line	:
City	:	ADRIAN
State	:	GA
Zip	:	31002-0394
Country	:	US
Telephone Number	:	478-278-1723
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 LUGENIA DR
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-7201
Country	:	US
Telephone Number	:	912-537-9355
Fax Number	:

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

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	08/10/2022

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