Healthcare Provider Details

I. General information

NPI: 1629993290
Provider Name (Legal Business Name): JEFFREY CADE WHITE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 HARKRIDER ST STE 6
CONWAY AR
72032-5690
US

IV. Provider business mailing address

803 HARKRIDER ST STE 6
CONWAY AR
72032-5690
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6170
  • Fax: 501-358-6170
Mailing address:
  • Phone:
  • Fax: 501-358-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5924
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: