Healthcare Provider Details

I. General information

NPI: 1245148162
Provider Name (Legal Business Name): KENDAL WHITE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

8906 TAYLOR LN
SHREVEPORT LA
71129-4353
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-4575
  • Fax:
Mailing address:
  • Phone: 318-464-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number229353
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: