MEDICARE: DR. KRYSTAL WHITE MED, MA, PHD CANDIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSYC.PY.00003880	WA

General Provider Information

NPI Number	:	1376607119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTAL WHITE MED, MA, PHD CANDIDA

Provider Business Mailing Address
First Line	:	3511 W PRICE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3635
Country	:	US
Telephone Number	:	303-333-4988
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 W PRICE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3635
Country	:	US
Telephone Number	:	303-333-4988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	03/02/2026

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