Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1073048732 |
---|---|
Provider Name | Jessica Nease White |
First Address | Fernandina Beach, FL 32034-4797 |
Second Address | Fernandina Beach, FL 32034-4797 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2017 |
Last Update Date | 01/05/2017 |