=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073939872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WYKEITA WHITE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2014
-----------------------------------------------------
Last Update Date | 05/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 388 W LITTLE YORK RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77076-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-656-1073
-----------------------------------------------------
Fax | 832-288-5695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3342
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77383-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-656-1073
-----------------------------------------------------
Fax | 832-288-5695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | WYKEITA WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-656-1073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 015093
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------