Healthcare Provider Details

I. General information

NPI: 1649716796
Provider Name (Legal Business Name): MEREDITH ALEXANDRA WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 DUBLIN RD
COLUMBUS OH
43215-1026
US

IV. Provider business mailing address

1211 DUBLIN RD
COLUMBUS OH
43215-1077
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-5200
  • Fax: 614-486-9665
Mailing address:
  • Phone: 614-486-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50004955RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004955RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: