Healthcare Provider Details

I. General information

NPI: 1558364299
Provider Name (Legal Business Name): LAURA P WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2005
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 STONECREST RD STE 101
SHELBYVILLE KY
40065-8142
US

IV. Provider business mailing address

140 STONECREST RD SUITE 101
SHELBYVILLE KY
40065-8142
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-6411
  • Fax: 502-633-6657
Mailing address:
  • Phone: 502-633-6411
  • Fax: 502-633-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28851
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: