Doctor Name: | MRS. TERESA RAE WHITE |
NPI Number: | 1578872354 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP, FNP-BC |
License Number: | 6657P |
Business Practice Address: | 209 W Main St Eddyville, KY - 420387752 |
Business Phone Number: | 2703880620 |
Business Fax Number: | 2703880604 |
Mailing Address: | 209 W Main St, EDDYVILLE |
State: | KY |
Postal Code: | 420387752 |
Phone Number: | 2703880620 |
Fax Number: | 2703880604 |
NPI Enumeration Date: | 09/28/2010 |
NPI Last Update Date: | 09/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 6657P |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |