Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP.07482 | LA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP07482 | LA |
NPI | 1033559174 |
---|---|
Provider Name | Jeffrey O'neal White |
First Address | Winnsboro, LA 71295-5424 |
Second Address | Delhi, LA 71232-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13944619 | CAQH (01) | |
2348337 | (05) | LA |
F06131093 | CERTIFICATION (01) |