Healthcare Provider Details

I. General information

NPI: 1679959365
Provider Name (Legal Business Name): JEFFERY WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 OUACHITA ST BOX 3652
ARKADELPHIA AR
71998-0001
US

IV. Provider business mailing address

2450 MADISON COUNTY ROAD 5555
HUNTSVILLE AR
72740
US

V. Phone/Fax

Practice location:
  • Phone: 501-467-0375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number693
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: