Healthcare Provider Details

I. General information

NPI: 1437632577
Provider Name (Legal Business Name): TERESA WHITE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CAL HILL SPUR
PINE KNOT KY
42635-9194
US

IV. Provider business mailing address

2517 GUELAT AVE
LOUISVILLE KY
40216-3038
US

V. Phone/Fax

Practice location:
  • Phone: 606-354-3155
  • Fax:
Mailing address:
  • Phone: 502-881-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011654
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011654
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: