Healthcare Provider Details

I. General information

NPI: 1922413954
Provider Name (Legal Business Name): MARY ANN WHITE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN WHITE APRN, FNP-C

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LINE AVE STE 200
SHREVEPORT LA
71101-4643
US

IV. Provider business mailing address

1500 LINE AVE STE 200
SHREVEPORT LA
71101-4643
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-5555
  • Fax: 318-629-5556
Mailing address:
  • Phone: 318-629-5555
  • Fax: 318-629-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07823
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: