Healthcare Provider Details

I. General information

NPI: 1043597800
Provider Name (Legal Business Name): JAYME N WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WEST ROUTE 38, SUITE A
MOORESTOWN NJ
08057
US

IV. Provider business mailing address

301 LIPPINCOTT DRIVE, SUITE 410
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-673-3960
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00272000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: