Healthcare Provider Details

I. General information

NPI: 1477745149
Provider Name (Legal Business Name): LORA M WHITE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 W PLEASANT RIDGE RD
ARLINGTON TX
76016-4427
US

IV. Provider business mailing address

7601 XAVIER DR
FORT WORTH TX
76133-7638
US

V. Phone/Fax

Practice location:
  • Phone: 817-478-6041
  • Fax:
Mailing address:
  • Phone: 817-423-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133487
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number190636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: