Healthcare Provider Details

I. General information

NPI: 1730633355
Provider Name (Legal Business Name): PATRICIA WHITE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WYOMING ST STE 202
MISSOULA MT
59801-1725
US

IV. Provider business mailing address

1315 WYOMING ST STE 202
MISSOULA MT
59801-1725
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9700
  • Fax: 620-663-5263
Mailing address:
  • Phone: 406-532-9700
  • Fax: 620-663-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMED-PAC-LIC-91167
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-91167
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: