Healthcare Provider Details

I. General information

NPI: 1639024219
Provider Name (Legal Business Name): MACKENZIE ASENATH WHITE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date: 03/07/2026
Reactivation Date: 05/04/2026

III. Provider practice location address

1545 HARBECK RD
GRANTS PASS OR
97527-5605
US

IV. Provider business mailing address

1215 SW G ST
GRANTS PASS OR
97526-2544
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-2373
  • Fax: 541-479-3514
Mailing address:
  • Phone: 541-476-2373
  • Fax: 541-479-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10058000
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: