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General NPI Number Information
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NPI Number | 1083142624
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Entity Type | Individual
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Provider Name | MRS. KENITRA LA'SHAE WHITE
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Gender | Female
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 22323 BRIDGESTONE PALM CT
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City | SPRING
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State | TX
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Zip | 77388-2891
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Country | US
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Telephone | 832-931-2925
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Fax |
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Provider Business Mailing Address
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Address Line | 22323 BRIDGESTONE PALM CT
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City | SPRING
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State | TX
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Zip | 77388-2891
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Country | US
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Telephone | 832-931-2925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 715202
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License Number State | TX
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