MEDICARE: JANAE HARRIS WHITE FNP

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	R882972	MS

General Provider Information

NPI Number	:	1376819748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAE HARRIS WHITE FNP

Provider Business Mailing Address
First Line	:	PO BOX 245
Second Line	:
City	:	FLORA
State	:	MS
Zip	:	39071-0245
Country	:	US
Telephone Number	:	601-573-9584
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N JERRY CLOWER BLVD
Second Line	:	SUITE M
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-5144
Country	:	US
Telephone Number	:	662-746-8962
Fax Number	:	662-746-8964

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	07/06/2016

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Directions to “ JANAE HARRIS WHITE FNP” Practice Location

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