Healthcare Provider Details

I. General information

NPI: 1407207640
Provider Name (Legal Business Name): HANNAH NEELY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 750
JACKSON MS
39216-4608
US

IV. Provider business mailing address

5339 CAROLWOOD DR
JACKSON MS
39211-4268
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4970
  • Fax:
Mailing address:
  • Phone: 601-672-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901606
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: