Healthcare Provider Details

I. General information

NPI: 1275237182
Provider Name (Legal Business Name): KELTY WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 HOSPITAL DR STE 103
SACRAMENTO CA
95823-5408
US

IV. Provider business mailing address

1350 E MAIN ST
GRASS VALLEY CA
95945-5208
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-1600
  • Fax:
Mailing address:
  • Phone: 530-477-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA201711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: