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General NPI Number Information
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NPI Number | 1104919240
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Entity Type | Individual
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Provider Name | KATRINA A WHITE PA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 145 MEMORIAL DRIVE
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City | BROKEN BOW
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State | NE
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Zip | 68822-0690
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Country | US
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Telephone | 308-872-2486
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Fax | 308-872-2027
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Provider Business Mailing Address
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Address Line | PO BOX 690
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City | BROKEN BOW
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State | NE
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Zip | 68822-0690
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Country | US
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Telephone | 308-872-2486
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Fax | 308-872-2027
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1174
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1174
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License Number State | NE
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