Healthcare Provider Details

I. General information

NPI: 1932003126
Provider Name (Legal Business Name): JOHN FERN WHITE III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DRINKWATER RD
BAY ST LOUIS MS
39520-1658
US

IV. Provider business mailing address

149 DRINKWATER RD
BAY ST LOUIS MS
39520-1658
US

V. Phone/Fax

Practice location:
  • Phone: 228-220-5338
  • Fax:
Mailing address:
  • Phone: 228-220-5338
  • Fax: 228-467-8665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number909181
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: