Healthcare Provider Details

I. General information

NPI: 1689615619
Provider Name (Legal Business Name): KIMBERLY A WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY A WHITE

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5193
  • Fax: 352-846-1455
Mailing address:
  • Phone: 352-294-5193
  • Fax: 352-846-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPT14824
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME62896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: