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NPI Code Detail

MEDICARE: KRISTA L WHITE LICSW

MEDICARE: KRISTA L WHITE LICSW
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
11041C0700XClinical Social WorkerDP00943805WV

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 : 1962693366
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA L WHITE LICSW
Provider Business Mailing Address
First Line : 145 HERON BAY RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-3595
Country : US
Telephone Number : 904-470-6900
Fax Number :
Provider Business Practice Location Address
First Line : 145 HERON BAY RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-3595
Country : US
Telephone Number : 904-470-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2007
Last Update Date : 10/02/2024

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Directions to “ KRISTA L WHITE LICSW” Practice Location

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