Healthcare Provider Details

I. General information

NPI: 1932400942
Provider Name (Legal Business Name): JESSICA WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2010
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTH PARK DR
LOUISVILLE CO
80027-9583
US

IV. Provider business mailing address

2297 BRISTOL ST
SUPERIOR CO
80027-8274
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1000
  • Fax:
Mailing address:
  • Phone: 203-535-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9250
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: