MEDICARE: ASHLEY SIMONE WHITE

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	347E00000X	Transportation Broker
2	347C00000X	Private Vehicle	D08494285	AZ

General Provider Information

NPI Number	:	1740967884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SIMONE WHITE

Provider Business Mailing Address
First Line	:	2601 WOODLAND PARK DR APT 8107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6174
Country	:	US
Telephone Number	:	602-577-3411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 WOODLAND PARK DR APT 8107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6174
Country	:	US
Telephone Number	:	602-577-3411
Fax Number	:

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

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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Directions to “ ASHLEY SIMONE WHITE ” Practice Location

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