=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366472870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVA M WHITE FNP C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 SOUTH LONG DRIVE SUITE G
-----------------------------------------------------
City | ROCKINGHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28379-4375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-997-3733
-----------------------------------------------------
Fax | 910-997-3707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 828
-----------------------------------------------------
City | HAMLET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28345-0828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-997-3733
-----------------------------------------------------
Fax | 910-997-3707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 200319
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------