Healthcare Provider Details

I. General information

NPI: 1750657680
Provider Name (Legal Business Name): TRACEY ANNE WHITE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BEAUFORT RD
HAVELOCK NC
28532
US

IV. Provider business mailing address

4389 BEAUFORT ROAD
HAVELOCK NC
28532
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-0543
  • Fax: 252-466-0382
Mailing address:
  • Phone: 252-466-0543
  • Fax: 252-466-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421094
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number447542
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: