Healthcare Provider Details

I. General information

NPI: 1033177175
Provider Name (Legal Business Name): JANE VICKNAIR WHITE PHD, RD, FADA, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY U-115
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1924 ALCOA HWY U-67
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9351
  • Fax: 865-544-9314
Mailing address:
  • Phone: 865-544-9352
  • Fax: 865-544-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN0000000086
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: