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NPI Code Detail

MEDICARE: PATRICIA WHITE FNP

MEDICARE:   PATRICIA  WHITE  FNP
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
1363LF0000XFamily Nurse PractitionerR125850MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659370229
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA WHITE FNP
Provider Business Mailing Address
First Line : 510 HIGHWAY 322
Second Line : P O BOX 1216
City : CLARKSDALE
State : MS
Zip : 38614-4717
Country : US
Telephone Number : 662-624-4292
Fax Number : 662-624-4354
Provider Business Practice Location Address
First Line : 2245 NORTH STATE STREET
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-7202
Country : US
Telephone Number : 662-627-4131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 12/31/2014

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Directions to “ PATRICIA WHITE FNP” Practice Location

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