Healthcare Provider Details

I. General information

NPI: 1659871044
Provider Name (Legal Business Name): MICHELLE WHITE APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SW LEE BLVD
LAWTON OK
73501-5711
US

IV. Provider business mailing address

PO BOX 2309
LAWTON OK
73502-2309
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6541
  • Fax: 580-250-6543
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0108815
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220304
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: